1 00:00:05,000 --> 00:00:08,080 >>WELCOME BACK TO ALL OF THE 2 00:00:08,080 --> 00:00:10,280 PANELISTS, PARTICIPANTS AND 3 00:00:10,280 --> 00:00:11,960 DISCUSSANTS. 4 00:00:11,960 --> 00:00:12,800 WE APPRECIATE ALL OF THE HARD 5 00:00:12,800 --> 00:00:14,160 WORK AND DISCRETIONARY EFFORT 6 00:00:14,160 --> 00:00:16,000 THAT YOU ALL HAVE SHOWED OVER 7 00:00:16,000 --> 00:00:18,120 THE PAST DAY, CONTINUING ON TO 8 00:00:18,120 --> 00:00:18,560 TODAY. 9 00:00:18,560 --> 00:00:20,320 I THINK THAT WE HAVE HAD A VERY 10 00:00:20,320 --> 00:00:24,120 RICH AND ROBUST DISCUSSION IN A 11 00:00:24,120 --> 00:00:24,920 MULTIDISCIPLINARY MANNER THAT 12 00:00:24,920 --> 00:00:26,760 REALLY CAPTURED SOME OF THE KEY 13 00:00:26,760 --> 00:00:28,960 ISSUES, DIALOGUE, AND POTENTIAL 14 00:00:28,960 --> 00:00:30,560 SOLUTIONS THAT WE WILL BE 15 00:00:30,560 --> 00:00:33,200 SYNTHESIZING THIS MORNING AS WE 16 00:00:33,200 --> 00:00:34,080 GO FORWARD. 17 00:00:34,080 --> 00:00:37,120 IT STARTED OFF WITH A GREAT 18 00:00:37,120 --> 00:00:38,880 KEYNOTE ADDRESS BY DR. SATCHER, 19 00:00:38,880 --> 00:00:40,600 AND THAT REALLY KICKED OFF SOME 20 00:00:40,600 --> 00:00:42,720 VERY ROBUST AND DETAILED 21 00:00:42,720 --> 00:00:44,360 DISCUSSIONS ABOUT SOME OF THE 22 00:00:44,360 --> 00:00:45,880 PROBLEMS THAT WE HAVE TO SORT OF 23 00:00:45,880 --> 00:00:47,760 FRAME AND ADDRESS, AND THEN COME 24 00:00:47,760 --> 00:00:50,360 UP WITH SOLUTIONS AS WE TRY TO 25 00:00:50,360 --> 00:00:52,520 REDUCE AND ELIMINATE INEQUITIES 26 00:00:52,520 --> 00:00:55,280 AND DISPARITIES IN ACUTE STROKE 27 00:00:55,280 --> 00:00:56,840 CARE ACCESS AND DELIVERY. 28 00:00:56,840 --> 00:00:57,960 AND WE'RE GOING TO BE HEARING 29 00:00:57,960 --> 00:00:59,720 ABOUT SOME OF THOSE PROBLEMS IN 30 00:00:59,720 --> 00:01:01,720 THE NEXT FEW MINUTES, AS WE GET 31 00:01:01,720 --> 00:01:03,160 THE REPORTS FROM THE VARIOUS 32 00:01:03,160 --> 00:01:04,680 TASK FORCE LEADERS. 33 00:01:04,680 --> 00:01:06,720 LET ME TAKE A MOMENT TO 34 00:01:06,720 --> 00:01:10,560 INTRODUCE MY CO-CHAIR, 35 00:01:10,560 --> 00:01:11,440 DR. BENSON. 36 00:01:11,440 --> 00:01:11,680 RICHARD? 37 00:01:11,680 --> 00:01:13,160 >> GOOD MORNING. 38 00:01:13,160 --> 00:01:14,520 YES, THANKS, DR. ALBERTS. 39 00:01:14,520 --> 00:01:16,200 WE HAD A GREAT DAY YESTERDAY, 40 00:01:16,200 --> 00:01:18,360 AND WE'RE EXCITED TO HEAR A 41 00:01:18,360 --> 00:01:19,720 SUMMARY OF ALL OF THE 42 00:01:19,720 --> 00:01:21,360 INFORMATION FROM YESTERDAY. 43 00:01:21,360 --> 00:01:25,920 THANK YOU. 44 00:01:25,920 --> 00:01:32,920 >> THANK YOU. 45 00:01:32,920 --> 00:01:34,440 GREG, DO YOU WANT TO BRING UP 46 00:01:34,440 --> 00:01:36,400 OTHER SLIDES? 47 00:01:36,400 --> 00:01:36,960 OR SAM? 48 00:01:36,960 --> 00:01:37,520 >> SURE. 49 00:01:37,520 --> 00:01:39,160 WHAT WOULD YOU LIKE US TO START 50 00:01:39,160 --> 00:01:39,360 WITH? 51 00:01:39,360 --> 00:01:40,880 >> SO I THINK WE'RE GOING TO 52 00:01:40,880 --> 00:01:44,160 START WITH OUR FIRST TASK FORCE, 53 00:01:44,160 --> 00:01:44,840 RIGHT? 54 00:01:44,840 --> 00:01:46,160 WITH OUR FIRST TIME POINT. 55 00:01:46,160 --> 00:01:49,160 I SEE CHARLES AND ERIKA ARE BOTH 56 00:01:49,160 --> 00:01:50,840 ON, SO IF YOU COULD BRING UP THE 57 00:01:50,840 --> 00:01:52,200 PRE-HOSPITAL SLIDES, GREG? 58 00:01:52,200 --> 00:01:52,560 >> SURE. 59 00:01:52,560 --> 00:02:06,360 ONE MOMENT. 60 00:02:06,360 --> 00:02:07,680 >> GREAT, THANK YOU. 61 00:02:07,680 --> 00:02:09,720 THANKS VERY MUCH, GREG. 62 00:02:09,720 --> 00:02:11,480 SO IT'S AN HONOR AND A PRIVILEGE 63 00:02:11,480 --> 00:02:13,480 AGAIN FOR COMMANDER ODOM AND I 64 00:02:13,480 --> 00:02:17,800 TO KIND OF PRESENT THE RESULTS 65 00:02:17,800 --> 00:02:20,280 OF THE BREAKOUT ROOMS 66 00:02:20,280 --> 00:02:23,680 CONVERSATIONS YESTERDAY. 67 00:02:23,680 --> 00:02:25,040 OBVIOUSLY IN THE AFTERNOON 68 00:02:25,040 --> 00:02:26,640 YESTERDAY, EVERYBODY WAS KIND OF 69 00:02:26,640 --> 00:02:29,560 GIVEN A HIGHLIGHTS FROM HAMLET, 70 00:02:29,560 --> 00:02:30,960 A SMALL GLIMMER OF WHAT THE 71 00:02:30,960 --> 00:02:32,200 CONVERSATIONS WITH ALLUDING TO, 72 00:02:32,200 --> 00:02:34,560 BUT TODAY WE LOOK FORWARD TO 73 00:02:34,560 --> 00:02:35,800 KIND OF TAKING A DEEPER DIVE 74 00:02:35,800 --> 00:02:36,560 GOING INTO THIS. 75 00:02:36,560 --> 00:02:38,000 WE CAN GO TO THE NEXT SLIDE, 76 00:02:38,000 --> 00:02:40,600 PLEASE, GREG. 77 00:02:40,600 --> 00:02:44,560 SO FIRST AND FOREMOST, COVERING 78 00:02:44,560 --> 00:02:46,520 THE GEOGRAPHY AREA, YOU KNOW, 79 00:02:46,520 --> 00:02:48,560 FIRST AND FOREMOST, THERE WERE 80 00:02:48,560 --> 00:02:54,720 NO CORRECTIONS OF THE ORIGINAL 81 00:02:54,720 --> 00:02:55,240 DISSEMINATED DOCUMENT. 82 00:02:55,240 --> 00:02:56,560 WE CAN GO TO THE NEXT SLIDE, 83 00:02:56,560 --> 00:02:58,880 GREG. 84 00:02:58,880 --> 00:03:01,040 AND THEN THESE WERE KIND OF THE 85 00:03:01,040 --> 00:03:03,240 OUTSTANDING QUESTIONS OR GAPS 86 00:03:03,240 --> 00:03:09,120 BROUGHT UP FOR CONSIDERATION. 87 00:03:09,120 --> 00:03:09,800 AND FIRST WAS, AS HAS BEEN 88 00:03:09,800 --> 00:03:14,680 BROUGHT UP IN SEVERAL OTHER TIME 89 00:03:14,680 --> 00:03:16,320 EPOCHS AS WELL, THE EDUCATION 90 00:03:16,320 --> 00:03:17,600 BARRIER FOR BOTH PROVIDERS AND 91 00:03:17,600 --> 00:03:21,960 PATIENTS IN UNDERSERVED AREAS. 92 00:03:21,960 --> 00:03:23,280 THEY'RE INFLUENCED, AS 93 00:03:23,280 --> 00:03:25,000 DR. BENSON TALKED ABOUT 94 00:03:25,000 --> 00:03:26,760 YESTERDAY, BY MULTIPLE SOCIAL 95 00:03:26,760 --> 00:03:29,760 DETERMINANTS OF HEALTH. 96 00:03:29,760 --> 00:03:32,560 NEXT WAS REGARDING LOGISTICAL 97 00:03:32,560 --> 00:03:35,520 BARRIERS AND CHALLENGES IN 98 00:03:35,520 --> 00:03:37,040 COMMUNICATION BETWEEN HOSPITALS 99 00:03:37,040 --> 00:03:40,760 AND PRE-HOSPITALS FOR STROKE 100 00:03:40,760 --> 00:03:43,160 SYSTEMS OF CARE AS WELL WITH 101 00:03:43,160 --> 00:03:44,680 MULTIPLE DIFFERENT SPOKE SITES, 102 00:03:44,680 --> 00:03:45,440 COMMUNICATION BETWEEN SPOKE 103 00:03:45,440 --> 00:03:48,720 SITES AND THE IDEA OF A COMMAND 104 00:03:48,720 --> 00:03:50,800 CENTER WAS AS WELL BROUGHT UP. 105 00:03:50,800 --> 00:03:53,000 NEXT AS WAS TALKED ABOUT AGAIN 106 00:03:53,000 --> 00:03:55,080 IN MULTIPLE GROUPS WAS THE 107 00:03:55,080 --> 00:03:57,920 ESSENCE OF ARTIFICIAL STATE 108 00:03:57,920 --> 00:03:59,200 BORDERS AND HOW THESE REALLY 109 00:03:59,200 --> 00:04:02,280 NEED TO BE REMOVED TO OPTIMIZE 110 00:04:02,280 --> 00:04:05,360 CARE IN A PATIENT-CENTERED 111 00:04:05,360 --> 00:04:09,280 PHILOSOPHICAL APPROACH. 112 00:04:09,280 --> 00:04:11,680 AND THEN ANOTHER ITEM WAS THE 113 00:04:11,680 --> 00:04:14,400 UNEVEN COVERAGE TIMELY ACCESS TO 114 00:04:14,400 --> 00:04:16,360 TELEMEDICINE AND NEUROLOGISTS, 115 00:04:16,360 --> 00:04:20,160 BUT ALSO TO HIGHLIGHT THAT OF 116 00:04:20,160 --> 00:04:21,160 NEUROINTERVENTIONALISTS AS WELL, 117 00:04:21,160 --> 00:04:23,440 WHICH ARE CRITICAL FOR THE 118 00:04:23,440 --> 00:04:24,320 STROKE SUBTYPES THAT WE TALKED 119 00:04:24,320 --> 00:04:26,160 ABOUT THAT HAVE THESE LARGE 120 00:04:26,160 --> 00:04:29,640 VESSEL OCCLUSIONS. 121 00:04:29,640 --> 00:04:31,960 AND THEN THE NEXT POINT IS THAT 122 00:04:31,960 --> 00:04:33,600 ALTHOUGH URBAN AREAS MAY BE MORE 123 00:04:33,600 --> 00:04:36,080 DENSELY POPULATED, ACCESS TO 124 00:04:36,080 --> 00:04:37,960 CARE MAY STILL BE AN ISSUE IN 125 00:04:37,960 --> 00:04:39,720 THIS GEOGRAPHICAL AREA RELATED 126 00:04:39,720 --> 00:04:41,880 TO POVERTY, CITIZENSHIP, 127 00:04:41,880 --> 00:04:44,760 INSURANCE STATUS OR OTHER 128 00:04:44,760 --> 00:04:47,160 MULTIFACTORIAL ISSUES. 129 00:04:47,160 --> 00:04:51,160 AND THEN FINALLY, ANOTHER GAP OF 130 00:04:51,160 --> 00:04:52,960 CONSIDERATION THAT MARK TALKED 131 00:04:52,960 --> 00:04:55,000 ABOUT YESTERDAY WAS THE COST OF 132 00:04:55,000 --> 00:04:57,600 EMS TO PATIENTS. 133 00:04:57,600 --> 00:05:00,920 FOR THOSE OF YOU WHO MAY HAVE 134 00:05:00,920 --> 00:05:02,560 BEEN IN AN AMBULANCE, THIS IS 135 00:05:02,560 --> 00:05:03,400 CERTAINLY A BILL THAT YOU CAN 136 00:05:03,400 --> 00:05:05,280 GET THAT MAY NOT BE NECESSARILY 137 00:05:05,280 --> 00:05:08,120 COVERED BY INSURANCE, THAT IS 138 00:05:08,120 --> 00:05:10,160 ABOVE $1,000 IF NOT A FEW 139 00:05:10,160 --> 00:05:11,360 THOUSAND DOLLARS. 140 00:05:11,360 --> 00:05:12,720 WE CAN GO TO THE NEXT SLIDE, 141 00:05:12,720 --> 00:05:15,960 PLEASE. 142 00:05:15,960 --> 00:05:18,000 AND SO THE BREAKOUT GROUP KIND 143 00:05:18,000 --> 00:05:21,960 OF IDENTIFIED SEVERAL ADDITIONAL 144 00:05:21,960 --> 00:05:23,600 ITEMS AS BEST PRACTICES OR 145 00:05:23,600 --> 00:05:28,560 SOLUTIONS TO CONSIDER, WITH ONE 146 00:05:28,560 --> 00:05:31,040 BEING TO INCENTIVIZE 147 00:05:31,040 --> 00:05:33,000 PROFESSIONALS, EMS AND 148 00:05:33,000 --> 00:05:34,480 PHYSICIANS TO SPECIALIZE IN 149 00:05:34,480 --> 00:05:35,160 STROKE IF POSSIBLE. 150 00:05:35,160 --> 00:05:36,720 AND I'LL ALSO ADD AS WELL, TO 151 00:05:36,720 --> 00:05:40,680 HAVE SOME SORT OF TRAINING OR 152 00:05:40,680 --> 00:05:44,160 CERTIFICATE OF TRAINING IN 153 00:05:44,160 --> 00:05:44,360 STROKE. 154 00:05:44,360 --> 00:05:50,040 AND FOR BACKGROUND IN THIS AREA, 155 00:05:50,040 --> 00:05:51,560 MANY OF US ARE FAMILIAR WITH 156 00:05:51,560 --> 00:05:52,440 ACLS TRAINING. 157 00:05:52,440 --> 00:05:53,800 IT'S CONCEIVABLE THAT THE 158 00:05:53,800 --> 00:05:58,360 UNIVERSITY OF MIAMI'S WORK FOR 159 00:05:58,360 --> 00:06:00,200 CREATING AN ASLS, ADVANCED 160 00:06:00,200 --> 00:06:01,760 STROKE LIFE SUPPORT COURSE, 161 00:06:01,760 --> 00:06:02,720 COULD POTENTIALLY BE SOMETHING 162 00:06:02,720 --> 00:06:09,320 THAT'S TRANSLATED TO HOSPITALS 163 00:06:09,320 --> 00:06:10,480 AND CENTERS FOR ALL APPROPRIATE 164 00:06:10,480 --> 00:06:13,960 STAFF TO HAVE. 165 00:06:13,960 --> 00:06:16,360 NEXT IS DISCUSSION REGARDING 166 00:06:16,360 --> 00:06:17,880 COMPREHENSIVE STROKE CENTERS 167 00:06:17,880 --> 00:06:20,360 BEING ABLE TO GOVERN THEIR 168 00:06:20,360 --> 00:06:21,920 SYSTEM OF CARE, AND INCLUDING 169 00:06:21,920 --> 00:06:23,560 THE PRE-HOSPITAL DOMAIN. 170 00:06:23,560 --> 00:06:24,840 AND AGAIN, SOMETHING THAT WAS 171 00:06:24,840 --> 00:06:26,960 BROUGHT UP WAS THE ESSENCE OF 172 00:06:26,960 --> 00:06:28,800 TALKING ABOUT A COMMAND CENTER 173 00:06:28,800 --> 00:06:31,160 THAT IS INVOLVED RIGHT FROM THE 174 00:06:31,160 --> 00:06:32,160 VERY BEGINNING WITH THE PATIENT 175 00:06:32,160 --> 00:06:32,960 STILL IN THE PREHOSPITAL SETTING 176 00:06:32,960 --> 00:06:36,560 THAT WILL HELP TO GET THAT 177 00:06:36,560 --> 00:06:42,680 PATIENT AS QUICKLY AS POSSIBLE 178 00:06:42,680 --> 00:06:44,320 TO THE MOST APPROPRIATE SITE 179 00:06:44,320 --> 00:06:46,720 WITHIN THEIR SYSTEM. 180 00:06:46,720 --> 00:06:51,600 NEXT IS, AS TECHNOLOGY AS 181 00:06:51,600 --> 00:06:52,600 EVOLVED, QUALITY OF CONNECTIVITY 182 00:06:52,600 --> 00:06:56,960 HAS GOTTEN BETTER, SO USING THIS 183 00:06:56,960 --> 00:06:59,480 WITH AMBULANCE PARTNERS IS OF 184 00:06:59,480 --> 00:07:00,800 THE UTMOST IMPORTANCE, SO NOT TO 185 00:07:00,800 --> 00:07:04,840 BE IN WIFI GAP AREAS. 186 00:07:04,840 --> 00:07:06,040 AND THEN -- AND THIS OBVIOUSLY 187 00:07:06,040 --> 00:07:08,360 IS SOMETHING THAT PLAYS AN 188 00:07:08,360 --> 00:07:11,400 IMPORTANT ROLE FOR THE 189 00:07:11,400 --> 00:07:12,040 PRE-HOSPITAL TELEMEDICINE THAT 190 00:07:12,040 --> 00:07:13,480 MAY BE PERFORMED. 191 00:07:13,480 --> 00:07:18,000 AND THEN FINALLY, AS INCENTIVES 192 00:07:18,000 --> 00:07:21,240 AND IMPLEMENTED INNOVATIONS FOR 193 00:07:21,240 --> 00:07:22,280 INTERVENTIONAL TEAMS, AS WE 194 00:07:22,280 --> 00:07:24,160 ALLUDED TO, TO HAVE MORE TIMELY 195 00:07:24,160 --> 00:07:25,360 ACCESS TO PATIENTS. 196 00:07:25,360 --> 00:07:28,080 AND THESE, AGAIN, THESE LARGE 197 00:07:28,080 --> 00:07:31,920 VESSEL OCCLUSION STROKES ARE THE 198 00:07:31,920 --> 00:07:35,840 ONES THAT CAN HAVE THE HIGHEST 199 00:07:35,840 --> 00:07:38,760 DEATH RATES AND THE MOST SEVERE 200 00:07:38,760 --> 00:07:39,360 DISABILITIES ASSOCIATED WITH 201 00:07:39,360 --> 00:07:40,840 THEM. 202 00:07:40,840 --> 00:07:43,040 SO THIS IS OF THE UTMOST 203 00:07:43,040 --> 00:07:43,360 IMPORTANCE. 204 00:07:43,360 --> 00:07:45,680 TIME IS BRAIN, AS EVERYBODY 205 00:07:45,680 --> 00:07:45,960 KNOWS. 206 00:07:45,960 --> 00:07:47,840 SO GETTING THESE PATIENTS TO 207 00:07:47,840 --> 00:07:49,520 THESE CENTERS AS QUICKLY AS 208 00:07:49,520 --> 00:07:51,360 POSSIBLE AND TO OUR 209 00:07:51,360 --> 00:07:53,560 INTERVENTIONALISTS IS IMPORTANT. 210 00:07:53,560 --> 00:07:55,280 AND THERE ARE A LOT OF DIFFERENT 211 00:07:55,280 --> 00:07:56,920 INNOVATIVE WAYS THAT SYSTEMS MAY 212 00:07:56,920 --> 00:07:57,560 IMPLEMENT THIS. 213 00:07:57,560 --> 00:07:59,440 FIXED WING HAS BEEN TALKED 214 00:07:59,440 --> 00:08:01,640 ABOUT, THERE'S BEEN CONVERSATION 215 00:08:01,640 --> 00:08:05,840 IN SOME SYSTEMS TRANSPORTING THE 216 00:08:05,840 --> 00:08:06,400 INTERVENTIONAL TEAM TO THE 217 00:08:06,400 --> 00:08:11,120 PATIENT OR TO AN AREA THAT'S 218 00:08:11,120 --> 00:08:11,800 CLOSER. 219 00:08:11,800 --> 00:08:14,400 SO THAT'S ANOTHER POINT. 220 00:08:14,400 --> 00:08:18,080 WE CAN GO TO THE NEXT SLIDE NOW. 221 00:08:18,080 --> 00:08:20,440 AND THIS WILL BE A REPORT OUT OF 222 00:08:20,440 --> 00:08:25,400 THE POLICY AND REGULATIONS 223 00:08:25,400 --> 00:08:26,360 BREAKOUT GROUP CONVERSATION. 224 00:08:26,360 --> 00:08:28,560 WE CAN GO TO THE NEXT SLIDE. 225 00:08:28,560 --> 00:08:32,160 AGAIN, THERE WEREN'T ANY 226 00:08:32,160 --> 00:08:33,800 CORRECTIONS OF THE ORIGINAL 227 00:08:33,800 --> 00:08:35,560 DOCUMENT THAT WAS DISSEMINATED. 228 00:08:35,560 --> 00:08:36,800 WE CAN GO TO THE NEXT SLIDE, 229 00:08:36,800 --> 00:08:39,360 PLEASE. 230 00:08:39,360 --> 00:08:41,000 AND FOR OUTSTANDING QUESTIONS OR 231 00:08:41,000 --> 00:08:43,560 GAPS TO CONSIDER, AS WAS TALKED 232 00:08:43,560 --> 00:08:45,760 ABOUT IN THE LARGE GROUP SESSION 233 00:08:45,760 --> 00:08:49,760 AS MARK AND OTHERS BROUGHT UP, 234 00:08:49,760 --> 00:08:53,040 MOBILE STROKE UNITS IS KIND OF 235 00:08:53,040 --> 00:08:54,920 SOMETHING TO REALLY POTENTIALLY 236 00:08:54,920 --> 00:08:57,640 FOCUS ON MORE. 237 00:08:57,640 --> 00:08:59,160 WITH MANY SUBSEQUENT QUESTIONS. 238 00:08:59,160 --> 00:09:00,560 WHAT IS THE FUNDING SOURCE, WHO 239 00:09:00,560 --> 00:09:05,400 HAS CONTROL, WHO PARTICIPATES? 240 00:09:05,400 --> 00:09:08,560 HOW TO PREVENT BEING USED TO 241 00:09:08,560 --> 00:09:09,640 INCREASE MARKET SHARE, AND 242 00:09:09,640 --> 00:09:10,960 AGAIN, YOU KNOW, KIND OF 243 00:09:10,960 --> 00:09:12,280 IMPLEMENTED IN THIS 244 00:09:12,280 --> 00:09:13,880 PATIENT-CENTERED APPROACH. 245 00:09:13,880 --> 00:09:18,640 AND HOW CAN MANAGEMENT BE 246 00:09:18,640 --> 00:09:19,360 COLLABORATIVE? 247 00:09:19,360 --> 00:09:20,920 AND THEN ANOTHER OUTSTANDING 248 00:09:20,920 --> 00:09:22,880 QUESTION WAS, THE GROUP WAS IN 249 00:09:22,880 --> 00:09:27,400 AGREEMENT THAT MOBILE STROKE 250 00:09:27,400 --> 00:09:29,960 UNITS SHOULD NOT BE LAUNCHED AS 251 00:09:29,960 --> 00:09:31,160 A STRATEGY TO INCREASE MARKET 252 00:09:31,160 --> 00:09:32,160 SHARE BY TAKING PATIENTS AWAY 253 00:09:32,160 --> 00:09:34,880 FROM A CLOSER MORE APPROPRIATE 254 00:09:34,880 --> 00:09:36,160 FACILITY AND THAT DISPOSITION 255 00:09:36,160 --> 00:09:37,400 SHOULD BE REGULATED BY THE STATE 256 00:09:37,400 --> 00:09:39,440 SUCH AS A COMMUNICATION CENTER. 257 00:09:39,440 --> 00:09:41,120 NEXT, ALL STATES SHOULD HAVE 258 00:09:41,120 --> 00:09:42,880 PROTOCOLS WHICH MAY BE 259 00:09:42,880 --> 00:09:43,720 REGIONALIZED DIRECTING PATIENTS 260 00:09:43,720 --> 00:09:45,040 TO THE CLOSEST APPROPRIATE 261 00:09:45,040 --> 00:09:45,520 FACILITY. 262 00:09:45,520 --> 00:09:48,360 FROM THE TIME OF SYMPTOM 263 00:09:48,360 --> 00:09:50,640 DETECTION AND LVO SCREENING. 264 00:09:50,640 --> 00:09:53,520 AND YOU KNOW, JUST A POINT TO 265 00:09:53,520 --> 00:09:55,440 TALK ABOUT FOR LVO SCREENING IS, 266 00:09:55,440 --> 00:09:57,280 THERE IS A LOT OF VARIABILITY IN 267 00:09:57,280 --> 00:10:00,000 TERMS OF THE UTILIZATION OF 268 00:10:00,000 --> 00:10:01,760 THESE PRE-HOSPITAL SCALES. 269 00:10:01,760 --> 00:10:03,400 AS MARK CAN ATTEST TO, IN OUR 270 00:10:03,400 --> 00:10:04,440 STATE OF CONNECTICUT, WE DO NOT 271 00:10:04,440 --> 00:10:09,960 HAVE A FORMAL LVO SCREENING 272 00:10:09,960 --> 00:10:13,040 SCALE STATEWIDE THAT IS 273 00:10:13,040 --> 00:10:14,520 PERFORMED WITHOUT READY AND EL 274 00:10:14,520 --> 00:10:15,440 IJ DECISIONS BEING DONE. 275 00:10:15,440 --> 00:10:17,880 SO THERE IS VARIABILITY IN THIS. 276 00:10:17,880 --> 00:10:21,760 AGAIN, I MENTIONED THE AHA 277 00:10:21,760 --> 00:10:24,440 INITIATIVE, THE ASLS COURSE THAT 278 00:10:24,440 --> 00:10:27,160 IS THE INNOVATION OF MIAMI. 279 00:10:27,160 --> 00:10:29,480 THERE'S ALSO A POTENTIAL -- 280 00:10:29,480 --> 00:10:31,680 POTENTIALLY AHA-FUNDED TARGET 281 00:10:31,680 --> 00:10:32,640 STROKE SURVEY THAT WILL BE 282 00:10:32,640 --> 00:10:33,760 COMING OUT TO STROKE CENTERS 283 00:10:33,760 --> 00:10:38,120 WITHIN THE NEXT FEW YEARS FROM 284 00:10:38,120 --> 00:10:38,880 ONE OF THE SCIENTIFIC 285 00:10:38,880 --> 00:10:40,840 SUBCOMMITTEES BY WHICH CENTERS 286 00:10:40,840 --> 00:10:42,600 ARE SURVEYED AS TO WHY THEY ARE 287 00:10:42,600 --> 00:10:45,120 NOT DOING PREHOSPITAL LVO 288 00:10:45,120 --> 00:10:47,160 SCREENING IN THEIR REGION, SO AS 289 00:10:47,160 --> 00:10:51,680 TO IDENTIFY THE OBSTACLES, THE 290 00:10:51,680 --> 00:10:53,800 BARRIERS AND THE DIVERSE 291 00:10:53,800 --> 00:10:55,560 OPINIONS THAT EXIST IN DIFFERENT 292 00:10:55,560 --> 00:10:59,160 REGIONS FOR THIS QUESTION. 293 00:10:59,160 --> 00:11:00,720 AND FINALLY, IS IT REASONABLE TO 294 00:11:00,720 --> 00:11:02,560 BELIEVE THAT WE COULD AGREE ON 295 00:11:02,560 --> 00:11:05,160 AN LVO SCREENING TOOL TO 296 00:11:05,160 --> 00:11:06,720 FACILITATE STANDARDIZED 297 00:11:06,720 --> 00:11:06,960 EDUCATION. 298 00:11:06,960 --> 00:11:08,920 IN THE ABSENCE OF THIS, 299 00:11:08,920 --> 00:11:09,760 TELESTROKE IN THE PRE-HOSPITAL 300 00:11:09,760 --> 00:11:11,160 SETTING IS ANEAR WAY TO BRING 301 00:11:11,160 --> 00:11:12,520 THE NEUROLOGIST IN THE BACK OF 302 00:11:12,520 --> 00:11:14,560 THE AMBULANCE TO HELP MAKE THESE 303 00:11:14,560 --> 00:11:15,120 ASSESSMENTS. 304 00:11:15,120 --> 00:11:19,240 WE CAN GO TO THE NEXT SLIDE. 305 00:11:19,240 --> 00:11:21,760 AND THEN FINALLY IN THIS DOMAIN, 306 00:11:21,760 --> 00:11:23,960 THE BEST PRACTICES OR SOLUTIONS 307 00:11:23,960 --> 00:11:26,680 FOR CONSIDERATION WERE, ONE, 308 00:11:26,680 --> 00:11:27,440 PRE-HOSPITAL REIMBURSEMENT AS WE 309 00:11:27,440 --> 00:11:30,720 HAD TALKED TO AND TYING TO THE 310 00:11:30,720 --> 00:11:31,720 COMPLEXITY OF CARE AND NOT 311 00:11:31,720 --> 00:11:33,200 PUTTING IT ON THE PATIENT. 312 00:11:33,200 --> 00:11:34,840 NUMBER TWO, LINKAGE TO THE 313 00:11:34,840 --> 00:11:36,840 PRE-HOSPITAL DATA AS WELL IS 314 00:11:36,840 --> 00:11:38,480 SOMETHING THAT WAS TALKED ABOUT. 315 00:11:38,480 --> 00:11:40,120 THERE ARE MANY COMPLICATING 316 00:11:40,120 --> 00:11:43,720 FACTORS THAT ARE INVOLVED IN 317 00:11:43,720 --> 00:11:43,960 THIS. 318 00:11:43,960 --> 00:11:45,560 AS MANY OF YOU MAY EXPERIENCE IN 319 00:11:45,560 --> 00:11:46,880 YOUR SYSTEM, SOMETIMES IT'S JUST 320 00:11:46,880 --> 00:11:48,760 A CHALLENGE TO GET THE 321 00:11:48,760 --> 00:11:50,040 PRE-HOSPITAL DATA ON AN 322 00:11:50,040 --> 00:11:51,560 INDIVIDUAL PATIENT IN YOUR 323 00:11:51,560 --> 00:11:55,560 SYSTEM, BUT CERTAINLY THERE IS 324 00:11:55,560 --> 00:11:56,280 IMPORTANT INFORMATION TO COME 325 00:11:56,280 --> 00:11:58,920 FROM EMS, INCLUDING BUT NOT 326 00:11:58,920 --> 00:12:00,880 LIMITED TO THE PATIENT'S CONTACT 327 00:12:00,880 --> 00:12:03,160 INFORMATION, THE PHONE NUMBER OF 328 00:12:03,160 --> 00:12:04,800 LOVED ONES WHO MAY NEED TO BE 329 00:12:04,800 --> 00:12:06,960 CONTACTED FOR THE LAST KNOWN 330 00:12:06,960 --> 00:12:07,440 NORMAL TIME. 331 00:12:07,440 --> 00:12:09,960 SO THIS IS A CRITICAL TRANSFER 332 00:12:09,960 --> 00:12:10,480 OF INFORMATION. 333 00:12:10,480 --> 00:12:12,760 AND THEN PRE-HOSPITAL EDUCATION 334 00:12:12,760 --> 00:12:14,400 AS WELL, AS WE HAD TALKED ABOUT 335 00:12:14,400 --> 00:12:17,360 THE TRAINING, THE CERTIFICATE 336 00:12:17,360 --> 00:12:20,280 PROGRAMS AND OTHER THINGS THAT 337 00:12:20,280 --> 00:12:21,560 WILL JUST COMPLEMENT AND ENHANCE 338 00:12:21,560 --> 00:12:23,200 OUR CURRENT SYSTEMS AS THEY 339 00:12:23,200 --> 00:12:24,840 EXIST. 340 00:12:24,840 --> 00:12:28,360 NEXT I'M GOING TO HAND OVER THE 341 00:12:28,360 --> 00:12:30,000 OTHER TWO THEME AREAS TO 342 00:12:30,000 --> 00:12:36,240 COMMANDER ODOM TO DISCUSS. 343 00:12:36,240 --> 00:12:37,560 >> THANK YOU SO MUCH. 344 00:12:37,560 --> 00:12:38,640 HI, EVERYONE. 345 00:12:38,640 --> 00:12:39,600 SO NEXT SLIDE, PLEASE. 346 00:12:39,600 --> 00:12:43,560 I'M GOING TO GO AHEAD AND GET 347 00:12:43,560 --> 00:12:46,400 STARTED ON THE ECONOMIC 348 00:12:46,400 --> 00:12:48,440 SELF-CARE RESOURCE AND THE 349 00:12:48,440 --> 00:12:48,920 DEMOGRAPHIC SECTION. 350 00:12:48,920 --> 00:12:50,560 SO NEXT SLIDE, PLEASE. 351 00:12:50,560 --> 00:12:52,520 WE DIDN'T HAVE ANY INFORMATION 352 00:12:52,520 --> 00:12:54,280 TO CORRECT IN THE ECONOMIC 353 00:12:54,280 --> 00:12:54,720 SECTION. 354 00:12:54,720 --> 00:12:57,320 NEXT SLIDE. 355 00:12:57,320 --> 00:12:59,400 SO SOME OUTSTANDING QUESTIONS OR 356 00:12:59,400 --> 00:13:02,040 GAPS THAT WERE CONSIDERED AMONG 357 00:13:02,040 --> 00:13:03,680 THE GROUP, AND I JUST WANT TO 358 00:13:03,680 --> 00:13:05,960 HIGHLIGHT, IT WAS A GREAT 359 00:13:05,960 --> 00:13:07,040 CONVERSATION IN BOTH THESE 360 00:13:07,040 --> 00:13:07,920 GROUPS YESTERDAY, SO THANK YOU 361 00:13:07,920 --> 00:13:10,360 SO MUCH FOR YOUR INPUT. 362 00:13:10,360 --> 00:13:14,800 FOR ECONOMICS AND HEALTHCARE 363 00:13:14,800 --> 00:13:16,360 RESOURCES, THE GROUP SUGGESTED 364 00:13:16,360 --> 00:13:18,480 THAT THERE BE A STANDARDIZATION 365 00:13:18,480 --> 00:13:21,280 AROUND REIMBURSEMENT FOR 366 00:13:21,280 --> 00:13:22,760 PROCEDURES AND CURRENTLY THERE'S 367 00:13:22,760 --> 00:13:25,560 A LOW REIMBURSEMENT RATE. 368 00:13:25,560 --> 00:13:26,800 WHETHER IT BE IN THE 369 00:13:26,800 --> 00:13:28,560 PRE-HOSPITAL SETTING OR 370 00:13:28,560 --> 00:13:30,160 IN-HOSPITAL SETTING, SO THAT'S 371 00:13:30,160 --> 00:13:31,720 SOME GAPS THAT NEED TO BE 372 00:13:31,720 --> 00:13:32,240 CONSIDERED. 373 00:13:32,240 --> 00:13:33,680 THERE'S A NEED FOR A NATIONAL 374 00:13:33,680 --> 00:13:36,400 STROKE REGISTRY AS MENTIONED 375 00:13:36,400 --> 00:13:37,960 PREVIOUSLY TO HAVE CONSISTENT 376 00:13:37,960 --> 00:13:41,000 DATA TO IDENTIFY DISPARITIES 377 00:13:41,000 --> 00:13:43,080 CONSISTENTLY ACROSS THE UNITED 378 00:13:43,080 --> 00:13:44,800 STATES AND REGIONS. 379 00:13:44,800 --> 00:13:47,200 AND IN ADDITION, THERE IS A NEED 380 00:13:47,200 --> 00:13:49,080 TO UNDERSTAND THE UTILITY OF 381 00:13:49,080 --> 00:13:52,760 TELESTROKE AND TELEMEDICINE AT 382 00:13:52,760 --> 00:13:55,960 THE DISPATCH, AS WELL AS 383 00:13:55,960 --> 00:13:56,960 PROVIDING, ONCE DISCHARGED IN 384 00:13:56,960 --> 00:13:58,560 TERMS OF PROVIDING EDUCATION TO 385 00:13:58,560 --> 00:14:00,000 PATIENTS. 386 00:14:00,000 --> 00:14:03,520 NEXT SLIDE, PLEASE. 387 00:14:03,520 --> 00:14:05,360 SO SOME NEW BEST PRACTICES OR 388 00:14:05,360 --> 00:14:10,360 SOLUTIONS TO CONSIDER FOR THE 389 00:14:10,360 --> 00:14:12,800 ECONOMICS AND HEALTHCARE 390 00:14:12,800 --> 00:14:14,560 RESOURCES SECTION IS TO CONSIDER 391 00:14:14,560 --> 00:14:15,360 SUPPORTING COMMUNITY EDUCATORS 392 00:14:15,360 --> 00:14:17,880 WHO ARE TRUSTED MEMBERS OF THE 393 00:14:17,880 --> 00:14:19,240 COMMUNITY, WHICH MAY INCLUDE 394 00:14:19,240 --> 00:14:20,960 NURSES, PHARMACISTS, COMMUNITY 395 00:14:20,960 --> 00:14:24,560 HEALTH WORKERS. 396 00:14:24,560 --> 00:14:25,640 IN ADDITION, A SUGGESTION WAS TO 397 00:14:25,640 --> 00:14:27,760 TEST IMPLEMENTATION OF VARIOUS 398 00:14:27,760 --> 00:14:30,880 EDUCATIONAL TOOLS AND 399 00:14:30,880 --> 00:14:31,640 METHODOLOGIES THROUGH 400 00:14:31,640 --> 00:14:35,040 DISSEMINATION AND IMPLEMENTATION 401 00:14:35,040 --> 00:14:36,160 RESEARCH, SO GETTING SOME OF 402 00:14:36,160 --> 00:14:37,440 THESE IDEAS AND QUESTIONS AND 403 00:14:37,440 --> 00:14:42,040 PUTTING THEM TO SCIENTIFIC 404 00:14:42,040 --> 00:14:43,080 RIGOROUS -- SCIENTIFICALLY 405 00:14:43,080 --> 00:14:44,560 RIGOROUS TESTING, WHETHER IT BE 406 00:14:44,560 --> 00:14:45,560 THROUGH QUALITATIVE OR 407 00:14:45,560 --> 00:14:47,160 QUANTITATIVE RESEARCH. 408 00:14:47,160 --> 00:14:49,240 IN ADDITION, IDENTIFYING 409 00:14:49,240 --> 00:14:52,320 BARRIERS TO USE OF 911, WHICH 410 00:14:52,320 --> 00:14:54,840 MAY INCLUDE MISTRUST OF LOCAL 411 00:14:54,840 --> 00:14:56,160 AUTHORITIES, IMPACT OF RACE AND 412 00:14:56,160 --> 00:14:58,760 RACIAL TENSIONS IN SOCIETY, A 413 00:14:58,760 --> 00:15:01,760 PRIVATE VERSUS PUBLIC MATTER, 414 00:15:01,760 --> 00:15:03,560 AND AFFORDABILITY OF DIALING 415 00:15:03,560 --> 00:15:04,000 911. 416 00:15:04,000 --> 00:15:06,680 SO WHAT IS THE COST TO THE 417 00:15:06,680 --> 00:15:09,360 PATIENTS WHO CHOOSE TO USE 911. 418 00:15:09,360 --> 00:15:13,280 AND THEN, AGAIN, THIS IDEA OF AN 419 00:15:13,280 --> 00:15:16,080 INCENTIVIZING INDIVIDUALS WHO GO 420 00:15:16,080 --> 00:15:21,560 INTO THE EMS PROFESSION OR EVEN 421 00:15:21,560 --> 00:15:23,600 THE STROKE/NEUROLOGIST 422 00:15:23,600 --> 00:15:24,520 PROFESSION TO INCREASE 423 00:15:24,520 --> 00:15:25,240 DIVERSITY. 424 00:15:25,240 --> 00:15:26,000 NEXT SLIDE, PLEASE. 425 00:15:26,000 --> 00:15:29,840 SO THE NEXT SECTION WAS THE 426 00:15:29,840 --> 00:15:30,760 DEMOGRAPHICS SESSION. 427 00:15:30,760 --> 00:15:31,600 NEXT SLIDE. 428 00:15:31,600 --> 00:15:34,560 AND WE DIDN'T HAVE ANY NEW 429 00:15:34,560 --> 00:15:36,080 CONTENT OR CORRECTION OF 430 00:15:36,080 --> 00:15:37,560 INFORMATION BROUGHT UP. 431 00:15:37,560 --> 00:15:42,320 NEXT SLIDE. 432 00:15:42,320 --> 00:15:44,080 SO SOME OUTSTANDING GAPS TO 433 00:15:44,080 --> 00:15:46,800 CONSIDER WITHIN THE DEMOGRAPHICS 434 00:15:46,800 --> 00:15:49,520 SECTION WAS TO IDENTIFY WAYS TO 435 00:15:49,520 --> 00:15:52,720 FURTHER ENHANCE 911 UTILIZATION 436 00:15:52,720 --> 00:15:54,960 THROUGH COMMUNITY 437 00:15:54,960 --> 00:15:55,760 EDUCATION/ENGAGEMENT WITH 438 00:15:55,760 --> 00:15:56,320 DIVERSE COMMUNITIES. 439 00:15:56,320 --> 00:16:00,000 SO AGAIN, IDENTIFYING THOSE -- 440 00:16:00,000 --> 00:16:02,200 WE WOULD NEED DATA TO IDENTIFY 441 00:16:02,200 --> 00:16:04,360 WHICH COMMUNITIES NEED WHAT 442 00:16:04,360 --> 00:16:05,360 INFORMATION AND WHO ARE THE 443 00:16:05,360 --> 00:16:08,120 TRUSTED RESOURCES AND HOLDERS OF 444 00:16:08,120 --> 00:16:10,160 THAT INFORMATION. 445 00:16:10,160 --> 00:16:12,080 BEING ABLE TO BUILD TRUST AND 446 00:16:12,080 --> 00:16:14,440 BREAK DOWN BARRIERS BY DOING 447 00:16:14,440 --> 00:16:17,160 THINGS FOR RATHER THAN TO A 448 00:16:17,160 --> 00:16:18,960 PARTICULAR COMMUNITY, AND 449 00:16:18,960 --> 00:16:20,600 IDENTIFYING, AGAIN, THOSE 450 00:16:20,600 --> 00:16:23,680 COMMUNITY CHAMPIONS. 451 00:16:23,680 --> 00:16:24,960 NEXT, THERE WAS THE SUGGESTION 452 00:16:24,960 --> 00:16:27,960 TO REMOVE ARTIFICIAL BARRIERS 453 00:16:27,960 --> 00:16:32,440 AND CROSSING STATE LINES WITHOUT 454 00:16:32,440 --> 00:16:33,760 INSURANCE PENALTY, SO DOING 455 00:16:33,760 --> 00:16:35,160 WHAT'S BEST FOR THE PATIENT, NOT 456 00:16:35,160 --> 00:16:38,040 JUST BASED ON SOME ARBITRARY 457 00:16:38,040 --> 00:16:39,760 LINE GOING TO THE RIGHT HOSPITAL 458 00:16:39,760 --> 00:16:43,760 FOR THAT PATIENT. 459 00:16:43,760 --> 00:16:45,960 IDENTIFYING STRATEGIES REGARDING 460 00:16:45,960 --> 00:16:48,040 PRE-HOSPITAL DISPATCH AND MOBILE 461 00:16:48,040 --> 00:16:54,600 STROKE UNIT UTILIZATION TO 462 00:16:54,600 --> 00:17:01,280 DECREASE DISPARITIES, AND REDUCE 463 00:17:01,280 --> 00:17:02,680 GEOGRAPHICAL DISPARITIES IN 464 00:17:02,680 --> 00:17:04,560 TRAVEL TIME WITH SPECIAL 465 00:17:04,560 --> 00:17:06,840 ATTENTION TO RURAL AND SPECIFIC 466 00:17:06,840 --> 00:17:09,000 DEMOGRAPHIC COMMUNITIES, IE, 467 00:17:09,000 --> 00:17:10,360 NATIVE AMERICANS. 468 00:17:10,360 --> 00:17:11,760 AUGMENTATION OF STROKE SYSTEM 469 00:17:11,760 --> 00:17:13,080 INTERACTION WITH NON-HE ENGLISH 470 00:17:13,080 --> 00:17:14,960 SPEAKING POPULATIONS SHOULD BE A 471 00:17:14,960 --> 00:17:16,840 PRIORITY, AND THEN FOR EMS 472 00:17:16,840 --> 00:17:17,960 AGENCIES WITH BANDWIDTH, 473 00:17:17,960 --> 00:17:19,640 LEVERAGING THEIR RESOURCES TO 474 00:17:19,640 --> 00:17:20,840 PERFORM COMMUNITY EDUCATION IN 475 00:17:20,840 --> 00:17:26,160 THE HOME OR COMMUNITY SETTING. 476 00:17:26,160 --> 00:17:27,560 NEXT, THERE WAS THE SUGGESTION 477 00:17:27,560 --> 00:17:30,160 TO CAPITALIZE UPON NOVEL SYSTEM 478 00:17:30,160 --> 00:17:33,000 INNOVATIONS FOR OTHER PATIENT 479 00:17:33,000 --> 00:17:35,760 POPULATIONS, AND EXPLORING THE 480 00:17:35,760 --> 00:17:40,240 FEASIBILITY OF APPLICATION OF 481 00:17:40,240 --> 00:17:43,520 THOSE INTERVENTIONS FOR STROKE 482 00:17:43,520 --> 00:17:45,360 POPULATIONS, AND THE SUGGESTION 483 00:17:45,360 --> 00:17:48,080 THERE WAS TELE-911. 484 00:17:48,080 --> 00:17:50,160 SO BEING ABLE TO IDENTIFY THE 485 00:17:50,160 --> 00:17:51,960 STROKE WITH DISPATCH. 486 00:17:51,960 --> 00:17:57,080 NEXT SLIDE, PLEASE. 487 00:17:57,080 --> 00:17:58,800 SO SOME NEW BEST PRACTICES OR 488 00:17:58,800 --> 00:18:01,120 SOLUTIONS TO CONSIDER WITHIN 489 00:18:01,120 --> 00:18:03,080 THIS GROUP CAME UP, THE 490 00:18:03,080 --> 00:18:04,160 UTILIZATION OF MULTIPLE 491 00:18:04,160 --> 00:18:06,280 COMPONENTS OF THE STROKE SYSTEM 492 00:18:06,280 --> 00:18:08,320 OF CARE TO PERFORM COMMUNITY 493 00:18:08,320 --> 00:18:11,920 ENGAGEMENT AND EDUCATION, SO NOT 494 00:18:11,920 --> 00:18:13,760 JUST FROM A NEUROLOGIST BUT ALL 495 00:18:13,760 --> 00:18:16,360 OF THE HOSPITAL STAFF, 496 00:18:16,360 --> 00:18:18,200 ESPECIALLY THOSE WELL EDUCATED 497 00:18:18,200 --> 00:18:21,800 ON STROKE, LIKE NURSES, EMS 498 00:18:21,800 --> 00:18:24,440 STAFF, EMERGENCY MEDICAL TEAMS, 499 00:18:24,440 --> 00:18:28,880 AND STROKE TEAMS. 500 00:18:28,880 --> 00:18:30,240 CONSIDER THE IDENTIFICATION AND 501 00:18:30,240 --> 00:18:33,160 UTILIZATION OF COMMUNITY 502 00:18:33,160 --> 00:18:33,400 CHAMPIONS. 503 00:18:33,400 --> 00:18:35,280 AGAIN, FOLKS IN THE CHURCHES OR 504 00:18:35,280 --> 00:18:36,760 COMMUNITIES WHO CAN BE EDUCATED 505 00:18:36,760 --> 00:18:39,760 ABOUT STROKE AND BE THOSE FOLKS 506 00:18:39,760 --> 00:18:43,920 THAT REACH OUT TO OTHERS TO 507 00:18:43,920 --> 00:18:45,880 SHARE INFORMATION AND COMPLEMENT 508 00:18:45,880 --> 00:18:49,360 THE INFORMATION THAT A PATIENT 509 00:18:49,360 --> 00:18:52,880 OR FAMILY MEMBER MIGHT RECEIVE 510 00:18:52,880 --> 00:18:54,800 WITHIN THE HOSPITAL SETTING. 511 00:18:54,800 --> 00:18:57,760 THE TRANSLATION OF KEY STROKE 512 00:18:57,760 --> 00:18:59,760 EDUCATIONAL RECOURSES INTO THE 513 00:18:59,760 --> 00:19:03,000 MOST PREVALENT LANGUAGES SPOKEN 514 00:19:03,000 --> 00:19:05,960 IN THE COMMUNITY. 515 00:19:05,960 --> 00:19:06,840 AGAIN, IDENTIFYING THOSE AREAS 516 00:19:06,840 --> 00:19:08,760 OR POCKETS WITHIN A COMMUNITY 517 00:19:08,760 --> 00:19:17,120 THAT MAY NEED SUPPORT OUTSIDE OF 518 00:19:17,120 --> 00:19:19,160 ENGLISH-SPEAKING, FAST EDUCATION 519 00:19:19,160 --> 00:19:21,160 OR BE FAST IN TRANSLATING THOSE 520 00:19:21,160 --> 00:19:23,960 SO MESSAGES TO THE LANGUAGE THAT 521 00:19:23,960 --> 00:19:24,760 IS PARTICULAR FOR THAT 522 00:19:24,760 --> 00:19:26,520 COMMUNITY. 523 00:19:26,520 --> 00:19:27,720 FURTHER INCORPORATION OF 524 00:19:27,720 --> 00:19:29,240 CULTURAL AND DEMOGRAPHIC 525 00:19:29,240 --> 00:19:31,400 COMPETENCY TRAINING INTO ANNUAL 526 00:19:31,400 --> 00:19:35,560 ONGOING EMS EDUCATION AND EMS 527 00:19:35,560 --> 00:19:36,440 PRE-CERTIFICATION PROGRAMS. 528 00:19:36,440 --> 00:19:39,400 AGAIN, EMS PROVIDERS ARE OFTEN 529 00:19:39,400 --> 00:19:40,920 THOSE FIRST PROVIDERS SEEN IN 530 00:19:40,920 --> 00:19:45,760 THE COMMUNITY SO HAVING CULTURAL 531 00:19:45,760 --> 00:19:48,480 COMPETENCE PARTICULARLY FOR A 532 00:19:48,480 --> 00:19:50,440 SPECIFIC COMMUNITY MIGHT BE 533 00:19:50,440 --> 00:19:52,760 HELPFUL IN GAINING THAT TRUST. 534 00:19:52,760 --> 00:19:54,920 AND THEN FURTHER BUILD UPON 535 00:19:54,920 --> 00:19:57,200 CURRENT NIH INITIATIVES WITH THE 536 00:19:57,200 --> 00:19:59,840 SPECIFIC FOCUS ON STROKE, 537 00:19:59,840 --> 00:20:01,560 PERFORMING RESEARCH INTO 538 00:20:01,560 --> 00:20:03,880 DISPARITIES AND STROKE CARE, 539 00:20:03,880 --> 00:20:06,360 EDUCATION, ACCESS TO THE SYSTEM, 540 00:20:06,360 --> 00:20:08,240 WHERE LGBTQ POPULATIONS AND WITH 541 00:20:08,240 --> 00:20:10,560 THE AIMS OF UNDERSTANDING THE 542 00:20:10,560 --> 00:20:11,880 UNIQUE BARRIERS AND CHALLENGES 543 00:20:11,880 --> 00:20:16,920 FOR ACCESS AND TERRITORIMENT. TREATMENT. 544 00:20:16,920 --> 00:20:18,400 I BELIEVE THAT IS OUR LAST 545 00:20:18,400 --> 00:20:18,600 SLIDE? 546 00:20:18,600 --> 00:20:18,800 YES. 547 00:20:18,800 --> 00:20:21,560 SO THANK YOU SO MUCH. 548 00:20:21,560 --> 00:20:24,280 FOR YOUR ATTENTION TO OUR 549 00:20:24,280 --> 00:20:24,880 PRE-HOSPITAL SESSION. 550 00:20:24,880 --> 00:20:26,440 DO WE HAVE ANY QUESTIONS OR DO 551 00:20:26,440 --> 00:20:30,080 WE NEED TO MOVE ON TO THE NEXT? 552 00:20:30,080 --> 00:20:32,800 >> THANK YOU SO MUCH, DR. ODOM 553 00:20:32,800 --> 00:20:35,640 AND DR. WIRA, FOR THAT EXCELLENT 554 00:20:35,640 --> 00:20:36,080 PRESENTATION. 555 00:20:36,080 --> 00:20:38,680 LET ME JUST ASK A FEW QUESTIONS 556 00:20:38,680 --> 00:20:42,520 HERE, AND THEN WE'LL MOVE ON. 557 00:20:42,520 --> 00:20:44,040 SOMETHING THAT DR. WIRA AND I 558 00:20:44,040 --> 00:20:45,680 ARE WELL AWARE OF IN THE GREAT 559 00:20:45,680 --> 00:20:47,480 STATE OF CONNECTICUT, BUT I 560 00:20:47,480 --> 00:20:48,840 SUSPECT THIS IS A NATIONAL 561 00:20:48,840 --> 00:20:50,920 PROBLEM, IS THE FRAGMENTATION OF 562 00:20:50,920 --> 00:20:51,560 EMS. 563 00:20:51,560 --> 00:20:53,200 I MEAN, IN OUR STATE HERE IN 564 00:20:53,200 --> 00:20:54,680 CONNECTICUT, WHICH IS NOT A 565 00:20:54,680 --> 00:20:56,960 LARGE STATE TO BE FRANK WITH 566 00:20:56,960 --> 00:21:01,200 YOU, WE HAVE DOZENS OF EMS 567 00:21:01,200 --> 00:21:03,280 COMPANIES, AND THERE'S NO BIG 568 00:21:03,280 --> 00:21:05,680 REGULATORY PERSON OR ENTITY THAT 569 00:21:05,680 --> 00:21:07,960 SORT OF HAS OVERSIGHT OF THEM. 570 00:21:07,960 --> 00:21:10,720 AND I SUSPECT IN MANY OTHER 571 00:21:10,720 --> 00:21:12,760 PARTS OF THE COUNTRY AND STATES, 572 00:21:12,760 --> 00:21:14,560 THEY ALSO -- IT'S SOMEWHAT OF AN 573 00:21:14,560 --> 00:21:16,040 EMS FREE-FOR-ALL. 574 00:21:16,040 --> 00:21:17,760 SOME STATES LIKE TEXAS HAVE A 575 00:21:17,760 --> 00:21:19,280 LITTLE BIT MORE CENTRAL 576 00:21:19,280 --> 00:21:21,040 CONTROLLING AUTHORITY, BUT IT'S 577 00:21:21,040 --> 00:21:24,440 THIS FRAGMENTATION OF EMS THAT 578 00:21:24,440 --> 00:21:25,840 REALLY CONCERNS ME, BECAUSE NO 579 00:21:25,840 --> 00:21:28,560 MATTER WHAT WE DEVELOP HERE IN A 580 00:21:28,560 --> 00:21:30,560 TASK FORCE, THE DIFFERENT EMS 581 00:21:30,560 --> 00:21:32,080 COMPANIES AND AGENCIES ARE 582 00:21:32,080 --> 00:21:34,480 BASICALLY GOING TO DO WHAT THEY 583 00:21:34,480 --> 00:21:36,000 WANT, UNLESS WE COME UP WITH A 584 00:21:36,000 --> 00:21:37,120 BETTER SOLUTION. 585 00:21:37,120 --> 00:21:40,040 SO I JUST WANTED TO OPEN THIS UP 586 00:21:40,040 --> 00:21:42,680 TO COMMANDER ODOM, DR. WIRA AND 587 00:21:42,680 --> 00:21:44,960 OTHERS, IF THIS PROBLEM THAT I'M 588 00:21:44,960 --> 00:21:47,920 TRYING TO EXPLAIN IS REALLY 589 00:21:47,920 --> 00:21:51,200 NATIONWIDE, AND IF SO, WHAT ARE 590 00:21:51,200 --> 00:21:52,520 SOME POTENTIAL SOLUTIONS? 591 00:21:52,520 --> 00:21:53,560 BECAUSE OTHERWISE, AT THE END OF 592 00:21:53,560 --> 00:21:55,040 THE DAY, IT'S SORT OF LIKE 593 00:21:55,040 --> 00:21:57,200 TRYING TO HERD CATS, AND THAT 594 00:21:57,200 --> 00:22:00,600 DOESN'T GO VERY WELL. 595 00:22:00,600 --> 00:22:01,960 >> I WANT TO MAKE A COMMENT. 596 00:22:01,960 --> 00:22:03,560 THANK YOU FOR BRINGING THAT -- 597 00:22:03,560 --> 00:22:05,400 IT'S RAFAEL. 598 00:22:05,400 --> 00:22:08,680 THANK YOU FOR BRINGING THAT ON. 599 00:22:08,680 --> 00:22:10,120 BECAUSE WE HAVE THE SAME PROBLEM 600 00:22:10,120 --> 00:22:12,400 HERE IN PUERTO RICO, AND THE 601 00:22:12,400 --> 00:22:14,280 THING IS THAT SOMETIMES THE 602 00:22:14,280 --> 00:22:18,600 HOSPITAL ADMINISTRATORS HAVE 603 00:22:18,600 --> 00:22:21,080 DEALS WITH THE EMS PEOPLE, SO 604 00:22:21,080 --> 00:22:24,160 THEY TAKE THE PATIENTS TO THEIR 605 00:22:24,160 --> 00:22:25,560 HOSPITAL INSTEAD, NO MATTER HOW 606 00:22:25,560 --> 00:22:28,760 FAR THEY ARE FROM THE HOSPITAL. 607 00:22:28,760 --> 00:22:32,000 SO THAT IS A BIG PROBLEM, AND 608 00:22:32,000 --> 00:22:35,200 THAT HARMS THE PATIENT, BECAUSE 609 00:22:35,200 --> 00:22:38,480 SOMETIMES IF YOU'RE HAVING A 610 00:22:38,480 --> 00:22:42,320 STROKE THAT OCCURRED NEAR MY 611 00:22:42,320 --> 00:22:43,160 HOSPITAL, WHY YOU ARE GOING TO 612 00:22:43,160 --> 00:22:47,440 TAKE THE PATIENT 45 MINUTES AWAY 613 00:22:47,440 --> 00:22:50,520 FROM OUR HOSPITAL TO GET 614 00:22:50,520 --> 00:22:51,560 TREATMENT? 615 00:22:51,560 --> 00:22:52,680 THAT'S THE SAME DISCUSSION WE 616 00:22:52,680 --> 00:22:55,080 HAD YESTERDAY IN TERMS OF THE 617 00:22:55,080 --> 00:22:56,080 U.S. -- ISLAND, THAT THEY FLY 618 00:22:56,080 --> 00:22:59,120 THE PATIENTS TO MIAMI INSTEAD OF 619 00:22:59,120 --> 00:23:02,600 BRINGING HERE TO PUERTO RICO. 620 00:23:02,600 --> 00:23:03,800 I THINK THAT THAT IS SOMETHING 621 00:23:03,800 --> 00:23:05,360 THAT HAS TO BE REGULATED. 622 00:23:05,360 --> 00:23:08,080 I THINK THAT MAYBE THE POLICIES 623 00:23:08,080 --> 00:23:11,040 AND REGULATIONS SECTION THAT 624 00:23:11,040 --> 00:23:15,080 THEY HAVE TO ADDRESS THAT AND 625 00:23:15,080 --> 00:23:17,440 MAYBE -- I THINK THE BEST WAY IS 626 00:23:17,440 --> 00:23:20,960 TO STANDARDIZE. 627 00:23:20,960 --> 00:23:21,880 POLICING SOME REGULATIONS ABOUT 628 00:23:21,880 --> 00:23:22,920 ALL OF THIS, BUT THIS IS 629 00:23:22,920 --> 00:23:24,120 SOMETHING THAT IS HAPPENING. 630 00:23:24,120 --> 00:23:26,080 I THINK THAT IT'S NATIONWIDE. 631 00:23:26,080 --> 00:23:27,800 WHEN I WAS DOING THE FELLOWSHIP, 632 00:23:27,800 --> 00:23:30,000 THE SAME THING HAPPENED. 633 00:23:30,000 --> 00:23:33,280 SO IT'S NOTHING NEW, YOU KNOW, 634 00:23:33,280 --> 00:23:34,600 THE SAME THING HAPPENED NOT ONLY 635 00:23:34,600 --> 00:23:36,240 WITH STROKE, THEY HAPPEN WITH 636 00:23:36,240 --> 00:23:43,000 OTHER NEUROSURGICAL CONDITIONS. 637 00:23:43,000 --> 00:23:44,640 TRAUMA, HEMORRHAGE. 638 00:23:44,640 --> 00:23:47,480 EMS PEOPLE ALREADY HAVE A 639 00:23:47,480 --> 00:23:49,240 CONTRACT OR THEY HAVE BIAS WITH 640 00:23:49,240 --> 00:23:51,320 CERTAIN HOSPITALS TO BRING 641 00:23:51,320 --> 00:23:52,600 PATIENTS TO THEIR E.R. 642 00:23:52,600 --> 00:23:55,160 SO THAT IS A -- IT'S A REAL 643 00:23:55,160 --> 00:23:58,640 THING HAPPENING. 644 00:23:58,640 --> 00:24:00,040 >> THANK YOU FOR SHARING THOSE 645 00:24:00,040 --> 00:24:01,040 CONCERNS AND EXAMPLES. 646 00:24:01,040 --> 00:24:04,560 YES, OTHER COMMENTS. 647 00:24:04,560 --> 00:24:04,760 SHERITA. 648 00:24:04,760 --> 00:24:06,360 >> I THINK ONE THING WE CAN DO 649 00:24:06,360 --> 00:24:07,520 IS WE CAN LOOK AT THE STATES 650 00:24:07,520 --> 00:24:08,680 THAT DO IT WELL. 651 00:24:08,680 --> 00:24:11,320 LIKE THA HAWAII DOES HAVE A 652 00:24:11,320 --> 00:24:12,720 CENTRALIZED EMS SYSTEM AND IT IS 653 00:24:12,720 --> 00:24:14,800 A LOT EASIER TO GET THINGS DONE 654 00:24:14,800 --> 00:24:18,240 AND IMPLEMENTED ACROSS THEIR 655 00:24:18,240 --> 00:24:19,680 WHOLE STATE, WHICH IS AMAZING 656 00:24:19,680 --> 00:24:21,080 BECAUSE THEY HAVE THE DIFFERENT 657 00:24:21,080 --> 00:24:22,600 ISLANDS AND THEY STILL ARE ABLE 658 00:24:22,600 --> 00:24:24,480 TO HAVE A CENTRALIZED EMS 659 00:24:24,480 --> 00:24:24,800 SYSTEM. 660 00:24:24,800 --> 00:24:26,120 SO I WOULD SAY THE FIRST STEP 661 00:24:26,120 --> 00:24:28,880 WOULD PROBABLY BE TO LOOK AT THE 662 00:24:28,880 --> 00:24:29,960 STATES THAT ARE DOING IT AND 663 00:24:29,960 --> 00:24:31,800 DOING IT WELL. 664 00:24:31,800 --> 00:24:33,680 >> THAT'S A GREAT POINT THAT YOU 665 00:24:33,680 --> 00:24:35,200 BRING UP, MARK, AND GREAT POINTS 666 00:24:35,200 --> 00:24:36,840 BY THE OTHERS AS WELL. 667 00:24:36,840 --> 00:24:38,360 YOU KNOW, WE SAID YESTERDAY THAT 668 00:24:38,360 --> 00:24:39,440 THERE'S NO TWO STROKES THAT ARE 669 00:24:39,440 --> 00:24:39,960 THE SAME. 670 00:24:39,960 --> 00:24:43,160 YOU CAN SAY THE SAME ABOUT EMS. 671 00:24:43,160 --> 00:24:45,360 THERE'S NO TWO EMS SYSTEMS THAT 672 00:24:45,360 --> 00:24:51,160 ARE IDENTICAL AS WELL. 673 00:24:51,160 --> 00:24:53,560 AND EMS SYSTEMS, THEY CAN HAVE 674 00:24:53,560 --> 00:24:54,960 THEIR STRENGTHS, THEIR 675 00:24:54,960 --> 00:24:56,320 WEAKNESSES, THEIR BARRIERS, 676 00:24:56,320 --> 00:24:58,560 THEIR OBSTACLES AND CAN HAVE 677 00:24:58,560 --> 00:25:00,560 RESOURCE ISSUES AND JUST -- 678 00:25:00,560 --> 00:25:02,160 THERE'S SUCH A WIDESPREAD 679 00:25:02,160 --> 00:25:03,800 DIVERSITY IN TERMS OF HOW SOME 680 00:25:03,800 --> 00:25:06,120 OF THEM MAY FUNCTION. 681 00:25:06,120 --> 00:25:09,800 TAKING A STEP BACK, ONE WAY THAT 682 00:25:09,800 --> 00:25:11,160 NATIONAL ADVOCACY 683 00:25:11,160 --> 00:25:11,920 ORGANIZATIONS -- AND THIS 684 00:25:11,920 --> 00:25:13,120 CERTAINLY HAS BEEN DONE IN SOME 685 00:25:13,120 --> 00:25:14,560 REGIONAL AREAS FOR STROKE AND 686 00:25:14,560 --> 00:25:17,120 ALSO FOR OTHER DISEASE ENTITIES, 687 00:25:17,120 --> 00:25:20,000 IS TO JUST MAKE RECOMMENDATIONS 688 00:25:20,000 --> 00:25:22,360 THAT THEN CAN BE BUILT UPON, 689 00:25:22,360 --> 00:25:24,560 BECAUSE SOMETIMES A 690 00:25:24,560 --> 00:25:26,240 RECOMMENDATION FROM AN ADVOCACY 691 00:25:26,240 --> 00:25:28,760 ORGANIZATION MAY NOT TRANSLATE 692 00:25:28,760 --> 00:25:31,400 IMMEDIATELY TO THE APPROPRIATE 693 00:25:31,400 --> 00:25:32,760 CORRESPONDING OEMS 694 00:25:32,760 --> 00:25:35,560 RECOMMENDATIONS FOR A STATE OR 695 00:25:35,560 --> 00:25:36,160 LEGISLATIVE CHANGES, BUT THEY 696 00:25:36,160 --> 00:25:37,960 CAN CERTAINLY GIVE GOOD 697 00:25:37,960 --> 00:25:40,840 AMMUNITION FOR MOVING THE NEEDLE 698 00:25:40,840 --> 00:25:42,080 FORWARD. 699 00:25:42,080 --> 00:25:45,400 POTENTIALLY A RENEWED AND 700 00:25:45,400 --> 00:25:48,280 FURTHER FOCUS ON KEY EMS STROKE 701 00:25:48,280 --> 00:25:49,760 PERFORMANCE METRICS. 702 00:25:49,760 --> 00:25:52,160 YOU KNOW, SOME REGIONS TALK 703 00:25:52,160 --> 00:25:54,240 ABOUT 911 TO DISPATCH TIME, 704 00:25:54,240 --> 00:25:58,080 DISPATCH TIME TO SITE ARRIVAL 705 00:25:58,080 --> 00:25:58,640 TIME. 706 00:25:58,640 --> 00:26:00,200 ONSET OF STROKE TO EMS TRANSFER 707 00:26:00,200 --> 00:26:02,160 TIME. 708 00:26:02,160 --> 00:26:04,960 ONSET OF STROKE TO STROKE CENTER 709 00:26:04,960 --> 00:26:05,640 ARRIVAL TIME. 710 00:26:05,640 --> 00:26:07,160 SO POTENTIALLY THERE COULD MAYBE 711 00:26:07,160 --> 00:26:08,920 BE SOME GUIDANCE FROM 712 00:26:08,920 --> 00:26:10,520 ORGANIZATIONS LIKE THE BRAIN 713 00:26:10,520 --> 00:26:12,400 DETECT COALITION AND AHA AND 714 00:26:12,400 --> 00:26:15,960 OTHER COALITIONS FOR 715 00:26:15,960 --> 00:26:17,720 PRE-HOSPITAL METRICS, AND THEN 716 00:26:17,720 --> 00:26:19,560 INDIVIDUAL SYSTEMS REGARDLESS OF 717 00:26:19,560 --> 00:26:21,880 HOW THEY'RE STRIVING TO 718 00:26:21,880 --> 00:26:23,600 FUNCTION, AT LEAST HAVE GOALS TO 719 00:26:23,600 --> 00:26:27,760 TRY TO ATTAIN AND ACHIEVE. 720 00:26:27,760 --> 00:26:29,400 >> AS I WAS GOING TO SAY THE 721 00:26:29,400 --> 00:26:34,200 SAME SORT OF TOPICS, IDENTIFYING 722 00:26:34,200 --> 00:26:37,040 WHAT BASIC DATA METRICS ARE 723 00:26:37,040 --> 00:26:39,440 REQUIRED ACROSS EMS SYSTEMS IN 724 00:26:39,440 --> 00:26:41,760 TERMS OF COLLECTION AND 725 00:26:41,760 --> 00:26:43,280 IDENTIFYING RECOMMENDATIONS LIKE 726 00:26:43,280 --> 00:26:48,360 STRONG RECOMMENDATIONS AROUND 727 00:26:48,360 --> 00:26:51,920 QUALITY METRICS FOR STROKE 728 00:26:51,920 --> 00:26:53,960 VICTIMS, INSTITUTING THAT AT 729 00:26:53,960 --> 00:26:55,640 SOME SORT OF REGIONAL OR STATE 730 00:26:55,640 --> 00:27:00,320 LEVEL TO TRY TO GET CLARITY 731 00:27:00,320 --> 00:27:02,360 ACROSS THE AGENCIES. 732 00:27:02,360 --> 00:27:03,800 >> THANK YOU ALL FOR THIS GREAT 733 00:27:03,800 --> 00:27:04,240 DISCUSSION. 734 00:27:04,240 --> 00:27:06,560 I KNOW THAT FOR THINGS LIKE 735 00:27:06,560 --> 00:27:08,160 TRAUMA, THERE'S REGULATORY AND 736 00:27:08,160 --> 00:27:10,160 STATE RULES AND REGULATIONS THAT 737 00:27:10,160 --> 00:27:14,200 EMS HAS TO TAKE CERTAIN FIEPS OF TYPES OF 738 00:27:14,200 --> 00:27:17,000 PATIENTS TO LEVEL 1 TRAUMA 739 00:27:17,000 --> 00:27:17,560 CENTERS, FOR EXAMPLE. 740 00:27:17,560 --> 00:27:19,560 I KNOW ANOTHER EXAMPLE IS TEXAS, 741 00:27:19,560 --> 00:27:21,200 EMS HAS TO TAKE STROKE PATIENTS 742 00:27:21,200 --> 00:27:23,000 TO THE NEAREST CERTIFIED STROKE 743 00:27:23,000 --> 00:27:23,440 CENTER. 744 00:27:23,440 --> 00:27:25,960 AND THESE CASES GET TRACKED. 745 00:27:25,960 --> 00:27:28,160 SO THE FINANCIAL INCENTIVES THAT 746 00:27:28,160 --> 00:27:29,960 THE GENTLEMAN FROM PUERTO RICO 747 00:27:29,960 --> 00:27:31,800 WAS TALKING ABOUT, THAT WOULDN'T 748 00:27:31,800 --> 00:27:33,960 HAPPEN IN TEXAS VERY OFTEN 749 00:27:33,960 --> 00:27:35,360 BECAUSE THEY COLLECT THAT DATA 750 00:27:35,360 --> 00:27:37,200 AND IF THEY END UP SHUNTING 751 00:27:37,200 --> 00:27:38,080 PATIENTS TO HOSPITALS THAT THEY 752 00:27:38,080 --> 00:27:39,400 MAY HAVE SOME FINANCIAL 753 00:27:39,400 --> 00:27:40,720 CONNECTION WITH THAT ARE NOT 754 00:27:40,720 --> 00:27:42,360 CERTIFIED STROKE CENTERS, THEY 755 00:27:42,360 --> 00:27:44,640 WOULD GET REPORTED UP TO THE 756 00:27:44,640 --> 00:27:45,600 GOVERNOR'S OFFICE WHO TRACKS 757 00:27:45,600 --> 00:27:47,160 THAT, AND THERE WOULD BE 758 00:27:47,160 --> 00:27:47,720 REPERCUSSIONS. 759 00:27:47,720 --> 00:27:49,440 SO THAT WOULD NOT BE AN ONGOING 760 00:27:49,440 --> 00:27:49,760 ISSUE. 761 00:27:49,760 --> 00:27:51,440 >> SO THEY HAVE POLICIES AND 762 00:27:51,440 --> 00:27:53,760 REGULATIONS REGARDING THAT? 763 00:27:53,760 --> 00:27:54,800 >> CORRECT. 764 00:27:54,800 --> 00:27:55,240 THEY DO. 765 00:27:55,240 --> 00:27:58,160 AND IN THE STATE OF TEXAS, YOU 766 00:27:58,160 --> 00:28:00,280 CAN BE CERTIFIED BY THE JOINT 767 00:28:00,280 --> 00:28:01,680 COMMISSION AS A -- IT'S A 768 00:28:01,680 --> 00:28:02,440 TWO-STEP PROCESS. 769 00:28:02,440 --> 00:28:04,280 YOU HAVE TO BE CERTIFIED AS A 770 00:28:04,280 --> 00:28:06,520 STROKE CENTER BY SOME 771 00:28:06,520 --> 00:28:07,280 INDEPENDENT ORGANIZATION, SUCH 772 00:28:07,280 --> 00:28:08,760 AS THE JOINT COMMISSION, BUT 773 00:28:08,760 --> 00:28:11,200 THEN THE STATE DESIGNATES YOU AS 774 00:28:11,200 --> 00:28:12,080 A STROKE CENTER. 775 00:28:12,080 --> 00:28:13,720 IT'S A TWO-STEP PROCESS. 776 00:28:13,720 --> 00:28:15,760 AND ONLY AFTER THE STATE 777 00:28:15,760 --> 00:28:17,800 DESIGNATION ARE THEN YOU IN A 778 00:28:17,800 --> 00:28:19,920 POSITION TO SEE ACUTE STROKE 779 00:28:19,920 --> 00:28:20,320 PATIENTS. 780 00:28:20,320 --> 00:28:22,400 SO IT'S A TWO-STEP. 781 00:28:22,400 --> 00:28:23,960 CERTIFIED BY AN INDEPENDENT 782 00:28:23,960 --> 00:28:24,960 BODY, RECOGNIZED BY THE STATE, 783 00:28:24,960 --> 00:28:26,440 AND THEN YOU GET PUT ON THIS 784 00:28:26,440 --> 00:28:28,400 LIST THAT EMS CAN TAKE STROKE 785 00:28:28,400 --> 00:28:29,280 PATIENTS TO YOU. 786 00:28:29,280 --> 00:28:31,800 AND YOU REALLY CAN'T BYPASS IT 787 00:28:31,800 --> 00:28:33,120 OR YOU CAN'T DO IT VERY MUCH, 788 00:28:33,120 --> 00:28:34,120 OTHERWISE YOU ARE CALLED TO 789 00:28:34,120 --> 00:28:35,080 ACCOUNT FOR THAT. 790 00:28:35,080 --> 00:28:36,600 BUT AGAIN, THAT'S TEXAS. 791 00:28:36,600 --> 00:28:37,600 IT'S NOT LIKE THAT IN OTHER 792 00:28:37,600 --> 00:28:43,080 STATES. 793 00:28:43,080 --> 00:28:44,360 OKAY. 794 00:28:44,360 --> 00:28:45,560 THIS IS A GREAT DISCUSSION. 795 00:28:45,560 --> 00:28:46,680 WE'RE CAPTURING THESE POINTS. 796 00:28:46,680 --> 00:28:51,960 >> MARK, THERE IS A HAND RAISED 797 00:28:51,960 --> 00:28:54,960 BY CHRISTOPHER RICHARDS. 798 00:28:54,960 --> 00:28:56,720 >> THANKS, EVERYONE. 799 00:28:56,720 --> 00:28:57,920 THIS IS OF COURSE A VERY 800 00:28:57,920 --> 00:28:58,640 INTERESTING CONVERSATION. 801 00:28:58,640 --> 00:29:01,320 WE MIGHT ALSO WANT TO THINK 802 00:29:01,320 --> 00:29:02,640 ABOUT LOOKING AT THE 803 00:29:02,640 --> 00:29:03,920 PRE-HOSPITAL APPROACH TO CARDIAC 804 00:29:03,920 --> 00:29:05,480 ARREST AS A MODEL AS WELL. 805 00:29:05,480 --> 00:29:07,480 SO IN A LOT OF RESPECTS, WE KIND 806 00:29:07,480 --> 00:29:12,000 OF SEE OUR EMS SYSTEMS, THEIR 807 00:29:12,000 --> 00:29:13,440 APPROACH TO OUT OF HOSPITAL 808 00:29:13,440 --> 00:29:15,160 CARDIAC ARREST MANAGEMENT AS A 809 00:29:15,160 --> 00:29:15,960 MARKER FOR HOW WELL YOU DO 810 00:29:15,960 --> 00:29:17,360 EVERYTHING ELSE. 811 00:29:17,360 --> 00:29:19,760 AND IT'S BEEN A REALLY GREAT WAY 812 00:29:19,760 --> 00:29:22,520 TO IMPROVE THE OVERALL CARE OF 813 00:29:22,520 --> 00:29:24,360 CARDIAC ARREST PATIENTS IN THE 814 00:29:24,360 --> 00:29:25,880 PRE-HOSPITAL SETTING THAT'S 815 00:29:25,880 --> 00:29:27,160 REALLY TRANSLATED TO OTHER KEY 816 00:29:27,160 --> 00:29:27,760 TYPES OF CONDITIONS. 817 00:29:27,760 --> 00:29:30,800 SO MAYBE EVEN THROUGH KIND OF 818 00:29:30,800 --> 00:29:32,000 MESSAGING AND COLLABORATION THAT 819 00:29:32,000 --> 00:29:35,160 WE HAVE WITH OUR EMS PARTNERS, 820 00:29:35,160 --> 00:29:37,360 USING APPROACH TO ACUTE STROKE 821 00:29:37,360 --> 00:29:40,320 BE THAT FROM DISPATCH, 822 00:29:40,320 --> 00:29:45,360 RECOGNITION THROUGH 823 00:29:45,360 --> 00:29:46,760 ON-SCENE SCREENING THROUGH THE 824 00:29:46,760 --> 00:29:48,600 EFFICIENCY OF CARE PROVIDED AS 825 00:29:48,600 --> 00:29:50,480 SEEN AS A MARKER FOR ACUTE CARE 826 00:29:50,480 --> 00:29:52,880 I THINK WOULD GO A LONG WAY HERE 827 00:29:52,880 --> 00:29:53,640 AS WELL. 828 00:29:53,640 --> 00:29:54,840 NOW THAT'S ALL PREDICATED ON 829 00:29:54,840 --> 00:29:56,600 THINGS LIKE DR. WIRA AND 830 00:29:56,600 --> 00:29:57,720 DR. ODOM YOU WERE MENTIONING AS 831 00:29:57,720 --> 00:29:59,440 WELL, WHICH IS TYING QUALITY 832 00:29:59,440 --> 00:30:00,760 METRICS, TYING REIMBURSEMENT TO 833 00:30:00,760 --> 00:30:02,360 THE COMPLEXITY OF CARE THAT'S 834 00:30:02,360 --> 00:30:04,240 PROVIDED, BECAUSE THAT'S REALLY 835 00:30:04,240 --> 00:30:05,920 REFLECTIVE OF KIND OF MOVING 836 00:30:05,920 --> 00:30:06,360 FORWARD. 837 00:30:06,360 --> 00:30:07,560 SOMETIMES THERE'S THE TOP-DOWN 838 00:30:07,560 --> 00:30:08,640 APPROACH THAT CAN WORK, BUT 839 00:30:08,640 --> 00:30:10,560 SOMETIMES IT CAN REALLY ALIENATE 840 00:30:10,560 --> 00:30:12,360 OUR EMS PARTNERS SO WE HAVE TO 841 00:30:12,360 --> 00:30:13,440 BE MINDFUL OF THAT AND REALLY 842 00:30:13,440 --> 00:30:16,000 KIND OF FRAME THE OVERALL CARE 843 00:30:16,000 --> 00:30:18,080 ON SCENE AS A MARKER OF, BOY, 844 00:30:18,080 --> 00:30:19,760 THIS IS REALLY HIGH QUALITY, 845 00:30:19,760 --> 00:30:21,680 EFFICIENT CARE THROUGH THIS 846 00:30:21,680 --> 00:30:23,880 VARIETY OF DIFFERENT METHODS. 847 00:30:23,880 --> 00:30:24,400 >> EXCELLENT. 848 00:30:24,400 --> 00:30:31,640 THANK YOU ALL. 849 00:30:31,640 --> 00:30:32,600 ANY OTHER QUESTIONS OR COMMENTS 850 00:30:32,600 --> 00:30:34,160 BEFORE WE GO ON TO THE NEXT TASK 851 00:30:34,160 --> 00:30:39,520 FORCE REPORT? 852 00:30:39,520 --> 00:30:42,000 IF NOT, THEN LET'S MOVE ON. 853 00:30:42,000 --> 00:30:43,440 WHO IS NEXT IN THE QUEUE FOR THE 854 00:30:43,440 --> 00:30:44,640 TASK FORCE? 855 00:30:44,640 --> 00:30:51,400 IS THAT LEE FOR HYPERACUTE 856 00:30:51,400 --> 00:30:51,640 THERAPY? 857 00:30:51,640 --> 00:30:52,120 >> I THINK SO. 858 00:30:52,120 --> 00:30:53,040 >> OKAY. 859 00:30:53,040 --> 00:30:58,240 CAN SOMEBODY BRING UP 860 00:30:58,240 --> 00:31:00,360 DR. JENSEN'S SLIDES? 861 00:31:00,360 --> 00:31:01,840 >> SO WHILE WE'RE BRINGING THE 862 00:31:01,840 --> 00:31:03,200 SLIDES UP, I JUST WANT TO SAY, 863 00:31:03,200 --> 00:31:04,640 WE HAD NO CORRECTIONS ACROSS OUR 864 00:31:04,640 --> 00:31:06,480 SECTIONS. 865 00:31:06,480 --> 00:31:08,760 UNFORTUNATELY, DR. HASSAN HAS A 866 00:31:08,760 --> 00:31:09,760 FAMILY ISSUE THAT HE HAS TO DEAL 867 00:31:09,760 --> 00:31:11,760 WITH SO I WILL BE PRESENTING 868 00:31:11,760 --> 00:31:13,880 ALSO THE INFORMATION FROM THE 869 00:31:13,880 --> 00:31:17,360 TWO SESSIONS THAT HE COVERED. 870 00:31:17,360 --> 00:31:20,320 ONE THING, THANK YOU VERY MUCH, 871 00:31:20,320 --> 00:31:20,960 DR. WIRA, DR. ODOM, FOR YOUR 872 00:31:20,960 --> 00:31:21,360 PRESENTATION. 873 00:31:21,360 --> 00:31:23,720 A LOT OF WHAT YOU SAID ACTUALLY 874 00:31:23,720 --> 00:31:25,880 BLED INTO -- WE BLED INTO YOUR 875 00:31:25,880 --> 00:31:27,320 PRE-HOSPITAL CARE, SOME OF THE 876 00:31:27,320 --> 00:31:28,640 THINGS I'M GOING TO TALK ABOUT 877 00:31:28,640 --> 00:31:32,560 ALSO BLEED INTO INPATIENT CARE. 878 00:31:32,560 --> 00:31:33,880 AND INTERESTINGLY, A LOT OF THE 879 00:31:33,880 --> 00:31:35,960 CONVERSATION HAD TO DO WITH THE 880 00:31:35,960 --> 00:31:37,560 EPOCH WE DIDN'T INCLUDE, WHICH 881 00:31:37,560 --> 00:31:42,560 IS THE POST-HOSPITAL CARE. 882 00:31:42,560 --> 00:31:46,400 SO IF YOU COULD GO TO THE NEXT 883 00:31:46,400 --> 00:31:46,920 SLIDE, PLEASE. 884 00:31:46,920 --> 00:31:49,000 SO THERE ARE OVERARCHING THEMES 885 00:31:49,000 --> 00:31:50,960 AMONG OUR FOUR CROSS-CUTTING 886 00:31:50,960 --> 00:31:51,560 THEMES. 887 00:31:51,560 --> 00:31:53,560 AND AGAIN, SOME OF THESE ARE NOT 888 00:31:53,560 --> 00:31:56,120 NECESSARILY JUST RELATED TO THE 889 00:31:56,120 --> 00:31:57,760 HYPERACUTE OR ACUTE SITUATION IN 890 00:31:57,760 --> 00:32:01,480 THE EMERGENCY DEPARTMENT. 891 00:32:01,480 --> 00:32:03,800 BUT ACROSS ALL THREE EPOCHS. 892 00:32:03,800 --> 00:32:06,520 AND IT CAME UP IN ALL OF THE 893 00:32:06,520 --> 00:32:07,040 BREAKOUT SESSIONS. 894 00:32:07,040 --> 00:32:08,360 ONE WAS THE COMMUNITY ENGAGEMENT 895 00:32:08,360 --> 00:32:10,200 THAT'S REQUIRED FOR US TO GET 896 00:32:10,200 --> 00:32:12,080 THE WORD OUT ABOUT STROKE 897 00:32:12,080 --> 00:32:13,720 EDUCATION, AND HOW THERE'S 898 00:32:13,720 --> 00:32:15,800 DEFINITELY A NEED TO PROMOTE 899 00:32:15,800 --> 00:32:20,360 TRUST IN NOT ONLY EMS BUT OTHER 900 00:32:20,360 --> 00:32:23,720 HEALTHCARE PROVIDERS WITH THE 901 00:32:23,720 --> 00:32:23,960 COMMUNITY. 902 00:32:23,960 --> 00:32:27,760 SO WE REALLY DO NEED TO WORK ON 903 00:32:27,760 --> 00:32:30,520 THAT SO THAT WHEN THEY COME TO 904 00:32:30,520 --> 00:32:32,480 THE HYPERACUTE PHASE, THEY ARE 905 00:32:32,480 --> 00:32:33,880 COMFORTABLE WITH MOVING ON 906 00:32:33,880 --> 00:32:36,280 THROUGH THE TREATMENT PHASE. 907 00:32:36,280 --> 00:32:38,000 ALSO, ANOTHER OVERARCHING THEME 908 00:32:38,000 --> 00:32:40,760 WAS JUST THE UTILIZATION OF ALL 909 00:32:40,760 --> 00:32:43,080 HEALTHCARE PROVIDERS, INTERESTED 910 00:32:43,080 --> 00:32:44,800 PARTIES, SO SO MUCH IN THE E.D. 911 00:32:44,800 --> 00:32:48,200 IS FOCUSED ON CARE PROVIDED BY 912 00:32:48,200 --> 00:32:49,360 THE PHYSICIANS AND OBVIOUSLY ONE 913 00:32:49,360 --> 00:32:51,920 OF THE ISSUES THAT CAME UP WAS 914 00:32:51,920 --> 00:32:55,960 THE NEED FOR MORE STROKE 915 00:32:55,960 --> 00:32:57,800 TRAINING FOR E.D. PHYSICIANS, 916 00:32:57,800 --> 00:33:02,640 BUT THE OTHER BIG CONVERSATION 917 00:33:02,640 --> 00:33:04,360 WAS AROUND USING ALL OF OUR 918 00:33:04,360 --> 00:33:07,200 HEALTHCARE PROVIDERS, 919 00:33:07,200 --> 00:33:08,360 IDENTIFYING STROKE PATIENTS AND 920 00:33:08,360 --> 00:33:12,680 GETTING THEM THROUGH THIS SYSTEM 921 00:33:12,680 --> 00:33:16,360 INTO EITHER THE ANGIO EXECUTE OR 922 00:33:16,360 --> 00:33:18,120 GETTING ITPA OR WHATEVER THEIR 923 00:33:18,120 --> 00:33:20,160 TREATMENT IS GOING TO BE, BY 924 00:33:20,160 --> 00:33:21,040 UTILIZING EVERYBODY THAT COMES 925 00:33:21,040 --> 00:33:22,240 IN CONTACT WITH THAT PATIENT. 926 00:33:22,240 --> 00:33:24,200 SO THAT INCLUDES THE NURSES THAT 927 00:33:24,200 --> 00:33:25,440 SEE THE PATIENTS AND THEY GET 928 00:33:25,440 --> 00:33:33,160 INTWHEN THEY GETINTO TRIAGE, UTILIZING NPs 929 00:33:33,160 --> 00:33:38,200 APAANDPAs TO DO THE INITIAL 930 00:33:38,200 --> 00:33:40,360 EVALUATION AND STROKE SCORE. 931 00:33:40,360 --> 00:33:41,520 UTILIZING YOUR PHARMACISTS AS 932 00:33:41,520 --> 00:33:43,000 PART OF YOUR TEAM. 933 00:33:43,000 --> 00:33:44,000 THEY'RE USUALLY PART OF THE TEAM 934 00:33:44,000 --> 00:33:46,400 ALREADY IF YOU'RE GETTING IVTPA, 935 00:33:46,400 --> 00:33:48,560 BUT WHERE ELSE CAN THEY BE 936 00:33:48,560 --> 00:33:50,360 UTILIZED IN DELIVERY OF CARE? 937 00:33:50,360 --> 00:33:51,760 AND THEN OF COURSE WE MOVED ON 938 00:33:51,760 --> 00:33:54,560 TO HOW CAN WE INCORPORATE 939 00:33:54,560 --> 00:33:55,200 RESIDENTS AND OTHER INDIVIDUALS 940 00:33:55,200 --> 00:33:56,880 SUCH AS HIGH SCHOOL STUDENTS AT 941 00:33:56,880 --> 00:33:59,400 SOME POINT IN TIME. 942 00:33:59,400 --> 00:34:00,280 OBVIOUSLY THE HIGH SCHOOL 943 00:34:00,280 --> 00:34:01,280 STUDENTS OUTSIDE OF THIS 944 00:34:01,280 --> 00:34:03,560 PARTICULAR EPOCH. 945 00:34:03,560 --> 00:34:05,200 ALSO, MAXIMIZING THE USE OF 946 00:34:05,200 --> 00:34:05,760 TECHNOLOGY. 947 00:34:05,760 --> 00:34:07,040 CLEARLY THERE ARE A LOT OF 948 00:34:07,040 --> 00:34:08,920 ISSUES AROUND ACCESS TO 949 00:34:08,920 --> 00:34:10,880 TELENEUROLOGY, BUT THERE'S ALSO 950 00:34:10,880 --> 00:34:12,080 OTHER TELEHEALTH TECHNOLOGY 951 00:34:12,080 --> 00:34:12,520 ISSUES. 952 00:34:12,520 --> 00:34:16,080 ONE OF THEM THAT WE RUN INTO IS 953 00:34:16,080 --> 00:34:21,000 ACCESS TO NEURORADIOLOGISTS TO 954 00:34:21,000 --> 00:34:23,600 HELP INTERPRET THE ADVANCED 955 00:34:23,600 --> 00:34:25,040 IMAGE, PARTICULARLY THE CT 956 00:34:25,040 --> 00:34:25,320 PERFUSION. 957 00:34:25,320 --> 00:34:26,920 THERE WERE A LOT OF RADIOLOGISTS 958 00:34:26,920 --> 00:34:29,160 THAT WORK AT THESE INDIVIDUAL 959 00:34:29,160 --> 00:34:30,840 HOSPITALS THAT ARE NOT 960 00:34:30,840 --> 00:34:33,760 COMFORTABLE WITH THAT, SO OFTEN 961 00:34:33,760 --> 00:34:35,680 YOU NEED MORE SUBSPECIALTY 962 00:34:35,680 --> 00:34:37,080 RADIOLOGY CARE OUTSIDE OF THE 963 00:34:37,080 --> 00:34:37,440 TELENEUROLOGIST. 964 00:34:37,440 --> 00:34:43,080 AND THIN TH THEN THE IDEA OF 965 00:34:43,080 --> 00:34:43,840 REPURPOSINGS CATH LABS TO 966 00:34:43,840 --> 00:34:47,240 PROVIDE ON-SITE THRO THROMBECTOMY 967 00:34:47,240 --> 00:34:48,600 CARE AT CERTAIN HOSPITALS WHICH 968 00:34:48,600 --> 00:34:52,240 GOES TO OUR OUT OF BOX THINKING 969 00:34:52,240 --> 00:34:54,800 LINE THERE, WHICH IS THE USE OF 970 00:34:54,800 --> 00:34:56,320 A MOBILE INTERVENTIONAL STROKE 971 00:34:56,320 --> 00:34:58,360 TEAM TO GET THE PATIENT -- 972 00:34:58,360 --> 00:35:00,760 INSTEAD OF GETTING THE PATIENT 973 00:35:00,760 --> 00:35:02,840 TO THE INTERVENTIONAL TEAM 974 00:35:02,840 --> 00:35:04,160 HAVING THE INTERVENTIONAL TEAM 975 00:35:04,160 --> 00:35:05,360 ACTUALLY GOING TO THE PATIENT. 976 00:35:05,360 --> 00:35:06,440 OBVIOUSLY THAT'S GOING TO 977 00:35:06,440 --> 00:35:09,840 REQUIRE USE OF AN ANGIO SUITE 978 00:35:09,840 --> 00:35:11,480 AND THE MOST COMMON ONES ARE 979 00:35:11,480 --> 00:35:14,280 CARDIAC CATH LABS. 980 00:35:14,280 --> 00:35:14,760 ALSO THINKING -- FORWARD 981 00:35:14,760 --> 00:35:16,320 THINKING AS WE MOVE ON INTO THE 982 00:35:16,320 --> 00:35:20,160 FUTURE IS THE USE OF ROBOTIC AND 983 00:35:20,160 --> 00:35:20,840 INSTRUMENTATION, WHICH IS 984 00:35:20,840 --> 00:35:22,680 CURRENTLY BEING USED IN SOME 985 00:35:22,680 --> 00:35:25,400 PLACES FOR CARDIAC PROCEDURES, 986 00:35:25,400 --> 00:35:27,520 WHERE ACTUALLY THE 987 00:35:27,520 --> 00:35:28,280 INTERVENTIONALIST DOES NOT NEED 988 00:35:28,280 --> 00:35:32,960 TO GO TO THE SITE BUT CAN 989 00:35:32,960 --> 00:35:35,240 ACTUALLY PERFORM THE PROCEDURE 990 00:35:35,240 --> 00:35:37,760 USING ROBOTIC INSTRUMENTATION. 991 00:35:37,760 --> 00:35:39,400 SO THAT'S COMING, SOMETHING WE 992 00:35:39,400 --> 00:35:40,840 SHOULD THINK ABOUT AND PERHAPS 993 00:35:40,840 --> 00:35:42,040 START TO INVESTIGATE EARLY. 994 00:35:42,040 --> 00:35:42,960 AND THEN OF COURSE RESEARCH 995 00:35:42,960 --> 00:35:43,360 OPPORTUNITIES. 996 00:35:43,360 --> 00:35:44,840 SO IF WE COULD GO TO THE NEXT 997 00:35:44,840 --> 00:35:47,280 SLIDE, PLEASE. 998 00:35:47,280 --> 00:35:49,560 SO IN TERMS OF THE GEOGRAPHY 999 00:35:49,560 --> 00:35:50,640 SUBGROUP, I'M GOING TO LOOK AT 1000 00:35:50,640 --> 00:35:53,520 THIS AS WHAT THE CONVERSATION 1001 00:35:53,520 --> 00:35:56,920 WAS AROUND AND WHAT INDIVIDUALS 1002 00:35:56,920 --> 00:35:59,520 IN THE SUBGROUP DISCUSSED AS 1003 00:35:59,520 --> 00:36:01,880 POSSIBLE FIXES FOR THE VARIOUS 1004 00:36:01,880 --> 00:36:02,120 ISSUES. 1005 00:36:02,120 --> 00:36:03,680 SO ONE OF THE MAJOR ISSUES WAS 1006 00:36:03,680 --> 00:36:05,400 ACCESS TO STROKE EXPERTISE OR 1007 00:36:05,400 --> 00:36:12,400 HIGHER LEVEL OF CARE, SUCH AS A 1008 00:36:12,400 --> 00:36:15,160 PSC HOSPITALS SENDING PATIENTS 1009 00:36:15,160 --> 00:36:21,560 UP TO TSCs, ONE GAP, HOW TO 1010 00:36:21,560 --> 00:36:24,040 GET THE PATIENT TO THE CLOSEST 1011 00:36:24,040 --> 00:36:25,240 STROKE HOSPITAL IF THEY NEED 1012 00:36:25,240 --> 00:36:26,400 THAT HIGHER LEVEL OF CARE, AND 1013 00:36:26,400 --> 00:36:28,120 IS THERE A WAY WE CAN USE 1014 00:36:28,120 --> 00:36:29,040 ARTIFICIAL INTELLIGENCE TO 1015 00:36:29,040 --> 00:36:30,480 DETERMINE WHERE THAT CLOSEST 1016 00:36:30,480 --> 00:36:31,800 AVAILABLE HOSPITAL IS, 1017 00:36:31,800 --> 00:36:32,480 REGARDLESS OF WHETHER OR NOT 1018 00:36:32,480 --> 00:36:33,880 IT'S IN THE SAME HEALTHCARE 1019 00:36:33,880 --> 00:36:34,280 SYSTEM. 1020 00:36:34,280 --> 00:36:36,080 IN OTHER WORDS, YOU USE 1021 00:36:36,080 --> 00:36:41,960 GEOGRAPHY AS OPPOSED TO THESE 1022 00:36:41,960 --> 00:36:43,160 ARTIFICIAL HEALTH SYSTEMS LIKE 1023 00:36:43,160 --> 00:36:45,240 YOU HAVE TO GO TO THE MOTHER 1024 00:36:45,240 --> 00:36:48,320 SHIP, WELL, THAT SHOULDN'T HAVE 1025 00:36:48,320 --> 00:36:50,240 TO -- THAT SHOULDN'T INTERFERE 1026 00:36:50,240 --> 00:36:51,040 WITH TRANSPORTING A PATIENT TO 1027 00:36:51,040 --> 00:36:53,200 THE CLOSEST STROKE HOSPITAL. 1028 00:36:53,200 --> 00:36:57,280 ALONG THOSE LINES, SINCE 1029 00:36:57,280 --> 00:36:58,160 PARTICULARLY IN THE SMALLER 1030 00:36:58,160 --> 00:36:59,360 STATES, THERE'S OVERLAPPING 1031 00:36:59,360 --> 00:37:00,640 HEALTH SYSTEMS THAT CROSS STATE 1032 00:37:00,640 --> 00:37:02,640 LINES, THERE NEEDS TO BE A 1033 00:37:02,640 --> 00:37:05,920 MECHANISM FOR ALLOWING EMS 1034 00:37:05,920 --> 00:37:06,880 SYSTEMS TO TAKE PATIENTS ACROSS 1035 00:37:06,880 --> 00:37:08,640 STATE LINES TO RECEIVE THAT 1036 00:37:08,640 --> 00:37:09,840 FASTER CARE. 1037 00:37:09,840 --> 00:37:11,720 CLEARLY THERE'S A NEED FOR MORE 1038 00:37:11,720 --> 00:37:14,560 STROKE TRAINING FOR E.D. 1039 00:37:14,560 --> 00:37:18,440 PHYSICIANS AND THE THOUGHT IS 1040 00:37:18,440 --> 00:37:21,280 PROVIDING MORE EDUCATION IN 1041 00:37:21,280 --> 00:37:22,920 THEIR RESIDENCIES. 1042 00:37:22,920 --> 00:37:25,120 ALSO HAVING CONTINUING MEDICAL 1043 00:37:25,120 --> 00:37:27,720 EDUCATION FOR THE E.D. -- 1044 00:37:27,720 --> 00:37:29,160 ALREADY PRACTICING E.D. 1045 00:37:29,160 --> 00:37:31,960 PHYSICIANS, AND ENCOURAGE STROKE 1046 00:37:31,960 --> 00:37:34,360 TRAINING OR ROTATION THROUGH 1047 00:37:34,360 --> 00:37:39,280 NEUROLOGY FOR BOTH PEOPLE 1048 00:37:39,280 --> 00:37:40,840 WANTING TO GO INTO EMERGENCY 1049 00:37:40,840 --> 00:37:42,040 MEDICINE BUT EVEN AT THE MEDICAL 1050 00:37:42,040 --> 00:37:42,480 SCHOOL LEVEL. 1051 00:37:42,480 --> 00:37:44,880 AND TO ENCOURAGE AND GROW 1052 00:37:44,880 --> 00:37:45,840 PHYSICIAN EXTENDERS, 1053 00:37:45,840 --> 00:37:49,320 PARTICULARLY ALONG THE LINES OF 1054 00:37:49,320 --> 00:37:52,360 P.A. AND/OR N.P. STROKE TEENS TEAMS 1055 00:37:52,360 --> 00:37:54,080 THAT CAN HELP TO IDENTIFY THESE 1056 00:37:54,080 --> 00:37:55,080 PATIENTS FASTER. 1057 00:37:55,080 --> 00:37:57,240 ALSO STROKE TRAINING FOR FIRST 1058 00:37:57,240 --> 00:37:59,440 RESPONDERS, YOU KNOW, BOTH EMS 1059 00:37:59,440 --> 00:38:02,480 AND IN THE E.D. PROPER SUCH AS 1060 00:38:02,480 --> 00:38:03,480 THE NURSES AND TECHS THAT OFTEN 1061 00:38:03,480 --> 00:38:05,360 ARE THE FIRST PEOPLE TO SEE 1062 00:38:05,360 --> 00:38:06,560 PATIENTS. 1063 00:38:06,560 --> 00:38:08,400 THE AVAILABILITY OF ADVANCED 1064 00:38:08,400 --> 00:38:09,880 IMAGING IN FACILITIES THAT SEE 1065 00:38:09,880 --> 00:38:10,280 STROKE PATIENTS. 1066 00:38:10,280 --> 00:38:11,360 IT'S REALLY IMPORTANT NOT ONLY 1067 00:38:11,360 --> 00:38:14,080 TO HAVE THE ABILITY TO DO C.T. 1068 00:38:14,080 --> 00:38:17,880 BUT ALSO CTA AND C.T. PER FUCHS. 1069 00:38:17,880 --> 00:38:22,360 AGAINPERFUSION.HAVING A TRAINED RADIOLOGIS T 1070 00:38:22,360 --> 00:38:29,200 THAT CAN ACTUALLY DETERMINE THAT INTERPRET THAT 1071 00:38:29,200 --> 00:38:31,160 IMAGING PROPERLY. 1072 00:38:31,160 --> 00:38:31,840 CROSS-CUTTING THEMES TALKING 1073 00:38:31,840 --> 00:38:34,640 ABOUT LOAN REPAYMENT PLANS FOR 1074 00:38:34,640 --> 00:38:39,040 PHYSICIANS WHO ARE IN J1 OR H-1B 1075 00:38:39,040 --> 00:38:44,400 PROGRAMS, TO IMPROVE ACCESS TO 1076 00:38:44,400 --> 00:38:46,360 CARE IN GEOGRAPHICALLY REMOTE OR 1077 00:38:46,360 --> 00:38:49,640 UNDERSERVED AREAS. 1078 00:38:49,640 --> 00:38:51,600 NEXT, PLEASE. 1079 00:38:51,600 --> 00:38:53,520 THE NEXT THOUGHT WAS IN TERMS OF 1080 00:38:53,520 --> 00:38:56,560 RESEARCH, WE NEED TO MOVE 1081 00:38:56,560 --> 00:38:59,080 MONSIGNOR TOWARDS 1082 00:38:59,080 --> 00:38:59,640 DISSEMINATION/IMPLEMENTATION 1083 00:38:59,640 --> 00:39:01,000 SCIENCE FUNDING OPPORTUNITIES, 1084 00:39:01,000 --> 00:39:03,560 AND ALSO FUNDING FOR -- AGAIN, 1085 00:39:03,560 --> 00:39:05,720 THIS IS OUTSIDE OF SORT OF OUR 1086 00:39:05,720 --> 00:39:07,720 EPOCH BUT IT CAME UP, FOR RURAL 1087 00:39:07,720 --> 00:39:09,200 COORDINATORS AND SUBACUTE TO 1088 00:39:09,200 --> 00:39:10,080 CHRONIC CARE COORDINATORS IN 1089 00:39:10,080 --> 00:39:13,800 ORDER TO PROMOTE RESEARCH IN THE 1090 00:39:13,800 --> 00:39:15,000 UNDERSERVED AND RURAL PATIENT 1091 00:39:15,000 --> 00:39:15,320 POPULATIONS. 1092 00:39:15,320 --> 00:39:17,840 SO YOU NEED PEOPLE TO 1093 00:39:17,840 --> 00:39:20,040 PARTICIPATE IN RESEARCH AND 1094 00:39:20,040 --> 00:39:22,360 TRYING TO GET THEM INVOLVED IN 1095 00:39:22,360 --> 00:39:23,960 THAT AT THE HYPERACUTE/ACUTE 1096 00:39:23,960 --> 00:39:25,800 LEVEL IS PROBLEMATIC, SO THE 1097 00:39:25,800 --> 00:39:27,560 IDEA IS TO ACTUALLY FUND PEOPLE 1098 00:39:27,560 --> 00:39:29,880 WHO CAN GO OUT INTO THE 1099 00:39:29,880 --> 00:39:31,960 COMMUNITY, PROMOTE RESEARCH, AND 1100 00:39:31,960 --> 00:39:33,240 THAT'S VIRGINIA BEACH AND NOT 1101 00:39:33,240 --> 00:39:40,920 EXPERIMENTATION SO THAAND -- BEING COMFORT ABLE BEING 1102 00:39:40,920 --> 00:39:43,560 INVOLVED IN RESEARCH. 1103 00:39:43,560 --> 00:39:44,960 AND MORE OPPORTUNITIES IN 1104 00:39:44,960 --> 00:39:47,520 RESEARCH, MARK, I THINK YOU 1105 00:39:47,520 --> 00:39:48,440 BROUGHT UP YESTERDAY HOW OFTEN 1106 00:39:48,440 --> 00:39:50,080 THOSE SORT OF PROPOSALS GET 1107 00:39:50,080 --> 00:39:51,360 SCORED LOW, AND SO THEY DON'T 1108 00:39:51,360 --> 00:39:53,920 GET FUNDED, AND THAT NEEDS TO -- 1109 00:39:53,920 --> 00:39:58,000 WE NEED TO SEE THAT AS A GAP AND 1110 00:39:58,000 --> 00:39:59,360 FIGURE OUT A WAY THAT THERE'S 1111 00:39:59,360 --> 00:40:01,680 MORE OBVIOUS FUNDING FOR THOSE 1112 00:40:01,680 --> 00:40:04,160 SORT OF RESEARCH PROJECTS. 1113 00:40:04,160 --> 00:40:08,000 ONE OF THE EXAMPLES THAT CAME UP 1114 00:40:08,000 --> 00:40:11,720 WAS THE ALTEPLASE USAGE 1115 00:40:11,720 --> 00:40:13,920 DISPARITIES, AND TESTING A PRE 1116 00:40:13,920 --> 00:40:15,200 AND POST -- PROVIDING A SCRIPT 1117 00:40:15,200 --> 00:40:16,920 TYPE OF SCENARIO. 1118 00:40:16,920 --> 00:40:21,080 THE NEXT ISSUE WAS TELEMEDICINE, 1119 00:40:21,080 --> 00:40:24,360 AND GR GRAND FROM THE V.A. GAVE 1120 00:40:24,360 --> 00:40:26,200 A VERY NICE SORT OF OVERVIEW OF 1121 00:40:26,200 --> 00:40:27,480 LESSONS THAT WE COULD TAKE FROM 1122 00:40:27,480 --> 00:40:33,160 THE V.A. MODEL, SUCH AS LICENSE 1123 00:40:33,160 --> 00:40:34,160 TELENEUROLOGISTS FROM ANY STATE 1124 00:40:34,160 --> 00:40:35,960 OR TERRITORY SO THEY CAN -- YOU 1125 00:40:35,960 --> 00:40:39,640 CAN USE THEM ACROSS STATE LINES. 1126 00:40:39,640 --> 00:40:41,080 RECRUIT NEUROLOGISTS FOR A 1127 00:40:41,080 --> 00:40:41,960 NATIONAL TELESTROKE PROGRAM, AND 1128 00:40:41,960 --> 00:40:44,360 THE USE OF ADVANCED PRACTICE 1129 00:40:44,360 --> 00:40:47,560 NURSES AS PHYSICIAN EXTENDERS 1130 00:40:47,560 --> 00:40:51,160 EVEN IN TELEMEDICINE. 1131 00:40:51,160 --> 00:40:53,160 THE POLICY AND REGULATIONS 1132 00:40:53,160 --> 00:40:54,360 SUBGROUP TALKED ABOUT IN TERMS 1133 00:40:54,360 --> 00:40:57,160 OF SYSTEMS OF CARE, POLICIES TO 1134 00:40:57,160 --> 00:40:58,880 PROMOTE STROKE SYSTEMS OF CARE 1135 00:40:58,880 --> 00:41:03,560 WWITHIN STATES AND REGIONS, A LA 1136 00:41:03,560 --> 00:41:07,200 THE REGIONAL COMMAND CENTERS IN 1137 00:41:07,200 --> 00:41:08,720 STROKENET, TO UTILIZE THE 1138 00:41:08,720 --> 00:41:10,000 COMPREHENSIVE STROKE CENTERS AS 1139 00:41:10,000 --> 00:41:11,680 HUBS FOR ACUTE STROKE PROTOCOLS 1140 00:41:11,680 --> 00:41:12,960 AND STROKE EDUCATION, SO 1141 00:41:12,960 --> 00:41:16,760 ACTUALLY MAKE IT THEIR 1142 00:41:16,760 --> 00:41:17,960 RESPONSIBILITY TO PROVIDE THOSE 1143 00:41:17,960 --> 00:41:24,760 SORT OF SERVICES TO THOSE FOLKS. 1144 00:41:24,760 --> 00:41:27,160 HAVE GEE GRFICALLY SENSIBLE 1145 00:41:27,160 --> 00:41:28,360 THROMBECTOMY TRIAGE, WORKING 1146 00:41:28,360 --> 00:41:29,880 THROUGH THAT WHOLE COMPETITIVE 1147 00:41:29,880 --> 00:41:31,160 MARKET AND MEDICAL SYSTEM SILOS 1148 00:41:31,160 --> 00:41:36,160 SO THAT WE BREAK DOWN THOSE 1149 00:41:36,160 --> 00:41:36,440 BARRIERS. 1150 00:41:36,440 --> 00:41:38,760 CONNECT STATE AND REGIONAL EMS 1151 00:41:38,760 --> 00:41:40,040 GOVERNANCE TO STROKE SYSTEMS OF 1152 00:41:40,040 --> 00:41:41,640 CARE SO YOU'RE TALKING THE SAME 1153 00:41:41,640 --> 00:41:42,680 LANGUAGE AND WORKING TOGETHER. 1154 00:41:42,680 --> 00:41:44,360 THAT MAY REQUIRE LEGISLATION AT 1155 00:41:44,360 --> 00:41:49,680 THE STATE LEVEL OR THE TERRITORY 1156 00:41:49,680 --> 00:41:51,960 LEVEL. 1157 00:41:51,960 --> 00:41:53,520 ALLOCATE STANDARDS AND RESOURCES 1158 00:41:53,520 --> 00:41:54,720 FROM INTERFACILITY TRANSPORT 1159 00:41:54,720 --> 00:41:55,800 FROM CRITICAL ACCESS HOSPITALS 1160 00:41:55,800 --> 00:41:57,880 TO STROKE CENTERS SO THAT THERE 1161 00:41:57,880 --> 00:42:00,280 ARE ACTUALLY STANDARDS OF CARE 1162 00:42:00,280 --> 00:42:02,360 ACROSS STATE AND REGIONS. 1163 00:42:02,360 --> 00:42:07,160 NEXT, PLEASE. 1164 00:42:07,160 --> 00:42:10,880 THIS IS FROM OUR TELEMEDICINE 1165 00:42:10,880 --> 00:42:15,160 EXPERTS. 1166 00:42:15,160 --> 00:42:16,080 DR. SUTHERLAND, I DON'T THINK 1167 00:42:16,080 --> 00:42:17,520 HE'S ON THE CALL TODAY, BUT HE 1168 00:42:17,520 --> 00:42:18,720 REALLY IS A LEADER IN THIS, AND 1169 00:42:18,720 --> 00:42:21,880 WE LOOK TO HIM FOR TALKING ABOUT 1170 00:42:21,880 --> 00:42:23,320 TELEMEDICINE. 1171 00:42:23,320 --> 00:42:25,800 SO ONE IS TO EXPAND LICENSURE TO 1172 00:42:25,800 --> 00:42:26,680 PERFORM TELESTROKE SERVICES 1173 00:42:26,680 --> 00:42:28,320 ACROSS STATE LINES AND REQUIRE 1174 00:42:28,320 --> 00:42:31,040 CONNECTIVITY FROM OUT OF STATE 1175 00:42:31,040 --> 00:42:32,760 PROVIDERS TO LOCAL PROVIDERS 1176 00:42:32,760 --> 00:42:35,760 AND/OR NETWORKS. 1177 00:42:35,760 --> 00:42:37,400 TO ALLOW UNIVERSAL CREDENTIALING 1178 00:42:37,400 --> 00:42:39,360 FROM HUB TO SPOKE AND MAINTAIN 1179 00:42:39,360 --> 00:42:40,760 ELIMINATION OF ORIGINATING SITE 1180 00:42:40,760 --> 00:42:44,960 RESTRICTIONS FOR TELESTROKE 1181 00:42:44,960 --> 00:42:45,280 SERVICES. 1182 00:42:45,280 --> 00:42:47,160 TO CONTINUE OR EXPAND 1183 00:42:47,160 --> 00:42:49,320 TELEMEDICINE COVERAGE USING THE 1184 00:42:49,320 --> 00:42:50,960 COVID-19 EMERGENCY AUTHORIZATION 1185 00:42:50,960 --> 00:42:53,200 ACT, AND PROMOTE POLICIES THAT 1186 00:42:53,200 --> 00:42:54,880 SUPPORT ACCESS TO HIGH QUALITY 1187 00:42:54,880 --> 00:42:56,400 BROADBAND FOR RURAL AND CRITICAL 1188 00:42:56,400 --> 00:42:59,240 ACCESS SETTINGS, INCLUDING 1189 00:42:59,240 --> 00:43:00,000 STROKE CARE. 1190 00:43:00,000 --> 00:43:02,880 AND WORK WITH ACGME TO ENSURE 1191 00:43:02,880 --> 00:43:04,960 THE INCLUSION OF TELESTROKE AND 1192 00:43:04,960 --> 00:43:07,000 TELEMEDICINE TRAINING. 1193 00:43:07,000 --> 00:43:10,400 NEXT, PLEASE. 1194 00:43:10,400 --> 00:43:12,240 AND RESEARCH. 1195 00:43:12,240 --> 00:43:15,760 AGAIN, EVERYBODY HAD SOME GREAT 1196 00:43:15,760 --> 00:43:19,880 RESEARCH IDEAS, SO FOR EXAMPLE, 1197 00:43:19,880 --> 00:43:23,040 NINDS REQUEST FOR APPLICATIONS 1198 00:43:23,040 --> 00:43:25,960 FOCUSED ON DISPARITIES AND ACUTE 1199 00:43:25,960 --> 00:43:30,360 TROAK TREATMENSTROKE TRIAGE AND INCLUDE 1200 00:43:30,360 --> 00:43:31,440 TELESTROKE AS A COMPONENT OF 1201 00:43:31,440 --> 00:43:33,800 ACUTE STROKE CLINICAL TRIALS 1202 00:43:33,800 --> 00:43:35,280 WITHIN STROKENET. 1203 00:43:35,280 --> 00:43:35,920 NEXT, PLEASE. 1204 00:43:35,920 --> 00:43:37,920 THE DEMOGRAPHIC SUBGROUP FOCUSED 1205 00:43:37,920 --> 00:43:40,280 A LOT ON RESEARCH AND EDUCATION, 1206 00:43:40,280 --> 00:43:43,240 AND I THINK DR. WIRA AND 1207 00:43:43,240 --> 00:43:44,440 DR. ODOM TALKED ABOUT THIS. 1208 00:43:44,440 --> 00:43:47,480 INVESTIGATE THE REASONS FOR 1209 00:43:47,480 --> 00:43:48,840 DISPARITY IN TPA USE IN AFRICAN 1210 00:43:48,840 --> 00:43:50,880 AMERICANS AND THE BARRIERS TO 1211 00:43:50,880 --> 00:43:54,360 CALLING 911, WHICH THEY 1212 00:43:54,360 --> 00:43:54,600 OUTLINED. 1213 00:43:54,600 --> 00:43:55,560 GET INTO HIGH LEVEL RESEARCH 1214 00:43:55,560 --> 00:43:56,680 THAT MOVES BEYOND ASSOCIATION, 1215 00:43:56,680 --> 00:43:58,760 REALLY GETS INTO CAUSATION. 1216 00:43:58,760 --> 00:44:00,280 REQUIRE MORE STROKE EDUCATION IN 1217 00:44:00,280 --> 00:44:02,160 MEDICAL SCHOOL AND RESIDENCY 1218 00:44:02,160 --> 00:44:04,760 TRAINING AND SHOULD MAYBE BE 1219 00:44:04,760 --> 00:44:06,080 MANDATED, THAT YOU GET STROKE 1220 00:44:06,080 --> 00:44:10,360 TRAINING OR DO A KNEWOLOGY NEUROLOGY 1221 00:44:10,360 --> 00:44:11,840 ROTATION AND ALSO STROKE 1222 00:44:11,840 --> 00:44:13,520 AWARENESS TRAINING FOR 1223 00:44:13,520 --> 00:44:14,280 NON-TRADITIONAL GROUPS. 1224 00:44:14,280 --> 00:44:15,960 A COUPLE EXAMPLES WERE THE 1225 00:44:15,960 --> 00:44:17,320 YOUNGER PATIENT POPULATION SUCH 1226 00:44:17,320 --> 00:44:19,920 AS THE MIND YOUR RISK FOR YOUNG 1227 00:44:19,920 --> 00:44:21,000 AFRICAN AMERICAN MEN OR 1228 00:44:21,000 --> 00:44:22,360 EDUCATION AT THE GRADE SCHOOL 1229 00:44:22,360 --> 00:44:23,320 LEVEL, SUCH AS KIDS HEART 1230 00:44:23,320 --> 00:44:23,840 CHALLENGE. 1231 00:44:23,840 --> 00:44:25,280 I REALIZE THIS IS, AGAIN, 1232 00:44:25,280 --> 00:44:26,360 OUTSIDE OF OUR EPOCH. 1233 00:44:26,360 --> 00:44:28,560 THIS IS WHAT CAME UP IN THE 1234 00:44:28,560 --> 00:44:29,120 BREAKOUT GROUPS. 1235 00:44:29,120 --> 00:44:30,400 AND ALSO LOOKING AT COMMUNITY 1236 00:44:30,400 --> 00:44:30,840 RESOURCES. 1237 00:44:30,840 --> 00:44:32,360 SO COULD MEDICAL STUDENTS 1238 00:44:32,360 --> 00:44:35,560 PERHAPS TAKE OWNERSHIP OF -- 1239 00:44:35,560 --> 00:44:36,760 MEDICAL SCHOOLS TAKE OWNERSHIP 1240 00:44:36,760 --> 00:44:38,360 OF COMMUNITY EDUCATION IN 1241 00:44:38,360 --> 00:44:41,440 REGIONS WHERE THERE IS A MEDICAL 1242 00:44:41,440 --> 00:44:42,280 SCHOOL. 1243 00:44:42,280 --> 00:44:44,080 HEALTH SYSTEM CERTIFICATION 1244 00:44:44,080 --> 00:44:45,480 REQUIRING MORE THAN TOKEN 1245 00:44:45,480 --> 00:44:46,600 COMMUNITY INVOLVEMENT. 1246 00:44:46,600 --> 00:44:48,320 SO YOU HAVE TO ACTUALLY HAVE, 1247 00:44:48,320 --> 00:44:49,880 FOR EXAMPLE, A FOCUSED PROGRAM, 1248 00:44:49,880 --> 00:44:51,280 YOU CAN'T JUST GIVE A HEALTH 1249 00:44:51,280 --> 00:44:54,560 FAIR AND SAY, HEY, WE'VE MET OUR 1250 00:44:54,560 --> 00:44:55,120 CRITERIA. 1251 00:44:55,120 --> 00:44:56,400 FIND COMMUNITY CHAMPIONS AND PUT 1252 00:44:56,400 --> 00:44:58,360 THEM ON STROKE COMMITTEES. 1253 00:44:58,360 --> 00:45:00,880 AND MAKE CMS REIMBURSEMENT 1254 00:45:00,880 --> 00:45:02,200 DEPENDENT ON COMMUNITY 1255 00:45:02,200 --> 00:45:03,840 INVOLVEMENT. 1256 00:45:03,840 --> 00:45:10,280 NEXT, PLEASE. 1257 00:45:10,280 --> 00:45:11,800 THEN AGAIN BACK TO TECHNOLOGY, 1258 00:45:11,800 --> 00:45:14,360 HOW CAN WE HELP SMALLER AND 1259 00:45:14,360 --> 00:45:16,560 RURAL PSCs ACQUIRE TECHNOLOGY 1260 00:45:16,560 --> 00:45:18,000 THAT'S REQUIRED IN ORDER TO 1261 00:45:18,000 --> 00:45:20,520 PROVIDE STROKE CARE. 1262 00:45:20,520 --> 00:45:23,000 NETWORK SOFTWARE AND TELESTROKE 1263 00:45:23,000 --> 00:45:26,800 SERVICES, HOW DO THEY GET 1264 00:45:26,800 --> 00:45:27,960 REIMBURSED FOR THAT, CAN THERE 1265 00:45:27,960 --> 00:45:28,960 BE FUNDING FOR THAT? 1266 00:45:28,960 --> 00:45:30,240 SAME WITH IMAGING TECHNOLOGY. 1267 00:45:30,240 --> 00:45:34,280 HOW DO WE HELP LOPTS THA HOSPITALS THAT 1268 00:45:34,280 --> 00:45:35,600 NEED HIGHER LEVELS OF IMAGING 1269 00:45:35,600 --> 00:45:37,440 GET THAT, AND HOW DO WE NAVIGATE 1270 00:45:37,440 --> 00:45:40,080 THE KICKBACK LAWS THAT PREVENT 1271 00:45:40,080 --> 00:45:41,600 NETWORKS FROM GIFTING SOFTWARE 1272 00:45:41,600 --> 00:45:43,160 TO THEIR SMALLER HOSPITALS. 1273 00:45:43,160 --> 00:45:47,520 NEXT, PLEASE. 1274 00:45:47,520 --> 00:45:49,680 THE ECONOMICS SUBGROUP BREAKOUT 1275 00:45:49,680 --> 00:45:51,880 FOCUSED ON COSTS AND PERSONNEL, 1276 00:45:51,880 --> 00:45:53,600 SO MANY OF THE -- MUCH OF THEIR 1277 00:45:53,600 --> 00:45:54,960 FOCUS WAS ON THE TERRITORIES 1278 00:45:54,960 --> 00:45:56,560 LIKE PUERTO RICO, VIRGIN 1279 00:45:56,560 --> 00:45:58,120 ISLANDS, AND THE NATIVE AMERICAN 1280 00:45:58,120 --> 00:46:03,360 RESERVATIONS. 1281 00:46:03,360 --> 00:46:05,840 OBVIOUSLY THE GAP IS THE NEED 1282 00:46:05,840 --> 00:46:08,480 FOR ROW BEST TELESTROKE 1283 00:46:08,480 --> 00:46:08,920 SERVICES. 1284 00:46:08,920 --> 00:46:10,880 WHAT FUND SOMETHING THERE TO 1285 00:46:10,880 --> 00:46:12,200 SUPPORT THE TELESTROKE SERVICES 1286 00:46:12,200 --> 00:46:14,160 FOR THESE UNDERSERVED AREAS, AND 1287 00:46:14,160 --> 00:46:15,720 CAN WE GET STROKE COMMAND 1288 00:46:15,720 --> 00:46:21,720 CENTERS TO HELP MOVE PATIENTS TO 1289 00:46:21,720 --> 00:46:23,520 APPROPRIATE LOCATIONS FOR THE 1290 00:46:23,520 --> 00:46:24,400 STROKE CARE WITHIN THEIR 1291 00:46:24,400 --> 00:46:25,480 REGIONS. 1292 00:46:25,480 --> 00:46:31,040 THE NEED TO ATTRACT AND RETAIN 1293 00:46:31,040 --> 00:46:34,560 PERSONNEL OFTEN DO NOT WANT TO 1294 00:46:34,560 --> 00:46:35,560 WORK NECESSARILY IN REMOTE 1295 00:46:35,560 --> 00:46:35,880 AREAS. 1296 00:46:35,880 --> 00:46:41,600 SO AGAIN, THE MEDICAL STUDENTS 1297 00:46:41,600 --> 00:46:43,600 CAME UP IN PUERTO RICO WITH 1298 00:46:43,600 --> 00:46:48,640 THEIR MEDICAL SCHOOL TO STAY IN 1299 00:46:48,640 --> 00:46:49,320 THEIR COMMUNITY. 1300 00:46:49,320 --> 00:46:52,720 THE NEED FOR EQUITABLE MEDICARE 1301 00:46:52,720 --> 00:46:53,680 REIMBURSEMENT NEEDS TO BE 1302 00:46:53,680 --> 00:46:54,200 EVALUATED. 1303 00:46:54,200 --> 00:46:55,640 IN PUERTO RICO, THEY GET 40% 1304 00:46:55,640 --> 00:46:56,960 LESS THAN THE STATES AND THAT IS 1305 00:46:56,960 --> 00:46:58,600 UNFAIR AND INEQUITABLE. 1306 00:46:58,600 --> 00:47:01,240 AND THE NEED FOR BETTER 1307 00:47:01,240 --> 00:47:01,880 REIMBURSEMENT MODELS. 1308 00:47:01,880 --> 00:47:03,600 THE FACT THAT SMALLER HOSPITALS 1309 00:47:03,600 --> 00:47:05,400 CANNOT AFFORD THE INFRASTRUCTURE 1310 00:47:05,400 --> 00:47:09,960 AND THEY CANNOT BECOME A HIGHER 1311 00:47:09,960 --> 00:47:11,480 LEVEL OF CARE WITHOUT THE 1312 00:47:11,480 --> 00:47:14,680 REIMBURSEMENT NECESSARY FOR THE 1313 00:47:14,680 --> 00:47:23,920 INFRASTRUCTURE. 1314 00:47:23,920 --> 00:47:25,440 I THINK THAT'S MY LATION SLIGHT. 1315 00:47:25,440 --> 00:47:28,280 >LAST SLIDE. 1316 00:47:28,280 --> 00:47:29,480 >> THANK YOU VERY MUCH, LEE. 1317 00:47:29,480 --> 00:47:31,200 A LOT OF DIFFERENT ASPECTS OF 1318 00:47:31,200 --> 00:47:31,440 CARE. 1319 00:47:31,440 --> 00:47:33,840 SOMETHING THAT I WANTED TO JUST 1320 00:47:33,840 --> 00:47:37,560 BRING UP FOR CONSIDERATION, AND 1321 00:47:37,560 --> 00:47:39,560 YOU DO THIS ON A DAILY BASIS, 1322 00:47:39,560 --> 00:47:41,600 MANY OF US DO NOD, BUT I DO 1323 00:47:41,600 --> 00:47:42,720 REMEMBER YEARS AGO, THERE WAS A 1324 00:47:42,720 --> 00:47:47,320 LOT OF RESISTANCE TO I.V. TPA 1325 00:47:47,320 --> 00:47:48,160 THERAPY BECAUSE OF THE COST. 1326 00:47:48,160 --> 00:47:49,920 LIKE THE COST EXCEEDED THE 1327 00:47:49,920 --> 00:47:51,360 ENTIRE DRG FOR STROKE. 1328 00:47:51,360 --> 00:47:52,880 AND I WAS WONDERING IF YOU WERE 1329 00:47:52,880 --> 00:47:55,600 FACING THE SAME PUSHBACK FOR 1330 00:47:55,600 --> 00:47:58,640 ENDO VASCULAR THERAPY, IF THE 1331 00:47:58,640 --> 00:48:00,280 DRG -- AND YOU KNOW, WHAT CMS 1332 00:48:00,280 --> 00:48:02,560 DID IS THEY RAISED THE DRG, THE 1333 00:48:02,560 --> 00:48:04,440 REIMBURSEMENT FOR THE DRG FOR 1334 00:48:04,440 --> 00:48:06,040 TPA, THEY ACTUALLY CREATED A NEW 1335 00:48:06,040 --> 00:48:08,360 ONE SO THAT THE HOSPITALS COULD 1336 00:48:08,360 --> 00:48:11,960 GIVE TPA WITHOUT FEAR IT WOULD 1337 00:48:11,960 --> 00:48:13,280 CHEW UP ALL OF THE DRG. 1338 00:48:13,280 --> 00:48:15,960 IS THE SAME DYNAMIC WORKING FOR 1339 00:48:15,960 --> 00:48:17,520 ACUTE ENDO VASCULAR THERAPY, OR 1340 00:48:17,520 --> 00:48:19,320 IS IT MORE IMBALANCE OR ARE 1341 00:48:19,320 --> 00:48:20,240 THERE OPPORTUNITIES HERE TO 1342 00:48:20,240 --> 00:48:23,480 REMOVE BARRIERS? 1343 00:48:23,480 --> 00:48:24,280 >> WELL, THAT'S A GREAT 1344 00:48:24,280 --> 00:48:25,480 QUESTION, AND I HAVE TO SAY, I 1345 00:48:25,480 --> 00:48:27,880 HAVE WORKED IN FOUR DIFFERENT 1346 00:48:27,880 --> 00:48:31,400 HEALTHCARE SYSTEMS, NOW ALL IN 1347 00:48:31,400 --> 00:48:32,560 THE STATE OF VIRGINIA, BUT I 1348 00:48:32,560 --> 00:48:33,680 HAVE WORKED IN FOUR, AND THERE 1349 00:48:33,680 --> 00:48:35,520 HAS NEVER BEEN ANY PUSHBACK FROM 1350 00:48:35,520 --> 00:48:37,800 THE HOSPITAL. 1351 00:48:37,800 --> 00:48:38,240 NONE. 1352 00:48:38,240 --> 00:48:40,000 ABOUT WHETHER OR NOT WE'RE DOING 1353 00:48:40,000 --> 00:48:43,080 TOO MANY THRO THROMBECTOMIES OR 1354 00:48:43,080 --> 00:48:44,040 THEY'RE LOSING MONEY. 1355 00:48:44,040 --> 00:48:45,880 AND I THINK IT'S BECAUSE THE 1356 00:48:45,880 --> 00:48:47,320 REIMBURSEMENT IS SIGNIFICANT. 1357 00:48:47,320 --> 00:48:51,920 I HAVE TO SAY, THE PLACE WHERE 1358 00:48:51,920 --> 00:48:54,600 IT SEEMS TO BE MORE LIKELY WHERE 1359 00:48:54,600 --> 00:48:57,600 THE HOSPITAL MAY FIND LESS 1360 00:48:57,600 --> 00:49:00,760 PROFITABLE IS THE LENGTH OF STAY 1361 00:49:00,760 --> 00:49:02,160 IN TERMS OF GETTING PATIENTS OUT 1362 00:49:02,160 --> 00:49:04,720 TO REHAB. 1363 00:49:04,720 --> 00:49:07,760 SO THAT SEEMS TO BE, YOU KNOW, 1364 00:49:07,760 --> 00:49:10,520 IF ANYBODY HAS A 1365 00:49:10,520 --> 00:49:11,680 REIMBURSEMENTISH YOU'LL OR 1366 00:49:11,680 --> 00:49:13,760 HOSPITAL FINANCIAL ISSUE, IT'S 1367 00:49:13,760 --> 00:49:15,080 BECAUSE THESE PATIENTS MAY 1368 00:49:15,080 --> 00:49:17,080 LINGER LONGER IN THE HOSPITAL 1369 00:49:17,080 --> 00:49:19,360 THAN THEY REALLY NEED TO. 1370 00:49:19,360 --> 00:49:22,840 SO NO, THAT'S NOT COME UP, AT 1371 00:49:22,840 --> 00:49:24,120 LEAST NOT IN MY WORLD. 1372 00:49:24,120 --> 00:49:25,920 >> I WANT TO MAKE A COMMENT 1373 00:49:25,920 --> 00:49:29,680 BECAUSE I WORK WITH MANY 1374 00:49:29,680 --> 00:49:32,440 ADMINISTRATION IN DOING THIS. 1375 00:49:32,440 --> 00:49:34,200 THE GOOD THING FOR THE 1376 00:49:34,200 --> 00:49:35,160 ADMINISTRATION IS THAT WHEN YOU 1377 00:49:35,160 --> 00:49:39,440 DO A THROBBING BECK TO THROMBECTOMY, YOU D O A 1378 00:49:39,440 --> 00:49:42,960 DIAGNOSTIC ANGIOGRAM TOO. 1379 00:49:42,960 --> 00:49:45,160 SO -- THEY PAY WELL, EVEN 1380 00:49:45,160 --> 00:49:48,440 MEDICARE. 1381 00:49:48,440 --> 00:49:49,840 BUT THAT COMPENSATES THE LOSS OF 1382 00:49:49,840 --> 00:49:52,760 MONEY THAT THEY GET FROM THE 1383 00:49:52,760 --> 00:49:54,840 THROMBECTOMY, BECAUSE 1384 00:49:54,840 --> 00:49:55,960 THROMBECTOMY, MEDICARE DOESN'T 1385 00:49:55,960 --> 00:49:57,040 PAY TOO MUCH. 1386 00:49:57,040 --> 00:50:01,320 AS WELL AS TPA. 1387 00:50:01,320 --> 00:50:06,120 SO IT'S PROFITABLE TO THE 1388 00:50:06,120 --> 00:50:10,240 HOSPITAL BECAUSE THE DIAGNOSTIC 1389 00:50:10,240 --> 00:50:11,040 ANGIOGRAM AND OTHER REQUIREMENTS 1390 00:50:11,040 --> 00:50:14,080 THAT YOU HAVE, BEFORE YOU DO THE 1391 00:50:14,080 --> 00:50:14,960 THROMBECTOMY, THEY PAY GOOD TO 1392 00:50:14,960 --> 00:50:16,360 THE HOSPITAL, AND THEY 1393 00:50:16,360 --> 00:50:16,760 COMPENSATE. 1394 00:50:16,760 --> 00:50:20,160 I THINK THAT THAT'S WHY WE DON'T 1395 00:50:20,160 --> 00:50:22,880 SEE TOO MUCH DIFFERENT. 1396 00:50:22,880 --> 00:50:24,440 BUT THERE IS A BIG DIFFERENCE 1397 00:50:24,440 --> 00:50:28,360 BETWEEN TPA AND THE VASCULAR 1398 00:50:28,360 --> 00:50:28,600 TREATMENT. 1399 00:50:28,600 --> 00:50:30,560 >> YEAH, THERE ARE CARVEOUTS, 1400 00:50:30,560 --> 00:50:32,960 BUT THE DRG IS HIGHER FOR 1401 00:50:32,960 --> 00:50:33,880 THROMBECTOMY TOO. 1402 00:50:33,880 --> 00:50:34,440 >> YES. 1403 00:50:34,440 --> 00:50:35,760 >> JUSTIN OR KEVIN, DO YOU HAVE 1404 00:50:35,760 --> 00:50:37,880 ANYTHING YOU WANT TO ADD TO 1405 00:50:37,880 --> 00:50:38,080 THAT? 1406 00:50:38,080 --> 00:50:40,360 >> I WOULD AGREE WITH YOU, I'VE 1407 00:50:40,360 --> 00:50:42,360 NOT REALLY SEEN A PROBLEM WITH 1408 00:50:42,360 --> 00:50:42,880 THAT. 1409 00:50:42,880 --> 00:50:46,960 BUT I THINK IT MAY BE COMING, WE 1410 00:50:46,960 --> 00:50:48,000 SEE THE DEVICE COMPANIES ARE 1411 00:50:48,000 --> 00:50:49,560 MAKING MORE AND MORE EXPENSIVE 1412 00:50:49,560 --> 00:50:51,840 DEVICES AND PUSHING FOR MORE 1413 00:50:51,840 --> 00:50:54,480 EXPENSIVE DEVICES BEING USED SO 1414 00:50:54,480 --> 00:50:56,120 THAT'S EVENTUALLY GOING TO START 1415 00:50:56,120 --> 00:51:00,040 EATING AWAY AT THE DRG, 1416 00:51:00,040 --> 00:51:01,360 SOMETHING WE HAVE TO BE AWARE. 1417 00:51:01,360 --> 00:51:02,960 I WAS A LITTLE BIT SURPRISED 1418 00:51:02,960 --> 00:51:04,280 ABOUT THE EMPHASIS ON 1419 00:51:04,280 --> 00:51:05,520 INTERPRETATION OF IMAGING. 1420 00:51:05,520 --> 00:51:07,800 BECAUSE I THINK WE'VE AT LEAST 1421 00:51:07,800 --> 00:51:08,760 SEEN MANY HOSPITALS WHERE YOU 1422 00:51:08,760 --> 00:51:09,960 HAVE SORT OF A READ AND TREAT 1423 00:51:09,960 --> 00:51:11,480 POLICY FOR YOUR STROKE 1424 00:51:11,480 --> 00:51:12,280 NEUROLOGISTS, AND SO PERHAPS WE 1425 00:51:12,280 --> 00:51:14,560 WOULD MAYBE NEED TO EMPHASIZE 1426 00:51:14,560 --> 00:51:17,360 MORE THE EDUCATION OF OUR STROKE 1427 00:51:17,360 --> 00:51:18,560 NEUROLOGISTS AND OUR 1428 00:51:18,560 --> 00:51:19,360 ENDOVASCULAR SPECIALISTS BEING 1429 00:51:19,360 --> 00:51:21,280 ABLE TO INTERPRET THE IMAGING 1430 00:51:21,280 --> 00:51:22,520 AND MAKE DECISION ON THE IMAGING 1431 00:51:22,520 --> 00:51:25,000 AND NOT RELY ON A DIAGNOSTIC 1432 00:51:25,000 --> 00:51:25,880 NEURORADIOLOGIST TO DO THAT. 1433 00:51:25,880 --> 00:51:27,160 THAT WOULD KIND OF ELIMINATE 1434 00:51:27,160 --> 00:51:29,160 PART OF THAT PROBLEM. 1435 00:51:29,160 --> 00:51:31,240 >> THAT'S A GREAT POINT, I HAVE 1436 00:51:31,240 --> 00:51:32,880 TO SAY, LIVING IN THE WORLD OF 1437 00:51:32,880 --> 00:51:34,320 ACADEMIC MEDICINE, WE JUST READ 1438 00:51:34,320 --> 00:51:36,160 OUR OWN STUDIES AND THAT'S IT, 1439 00:51:36,160 --> 00:51:36,680 WE'RE DONE. 1440 00:51:36,680 --> 00:51:41,200 BUT HAVING WORKED IN THREE 1441 00:51:41,200 --> 00:51:42,520 NON-ACADEMIC BUT COMPREHENSIVE 1442 00:51:42,520 --> 00:51:46,880 STROKE CENTERS, YOU'LL FIND 1443 00:51:46,880 --> 00:51:47,920 THEY'RE SOMETIMES -- OBVIOUSLY 1444 00:51:47,920 --> 00:51:49,360 IF YOU'RE THE PERSON ON CALL AND 1445 00:51:49,360 --> 00:51:52,760 HAVING SOMETHING LIKE VIS AI 1446 00:51:52,760 --> 00:51:54,320 ALLOWING YOU TO SEE WHAT'S GOING 1447 00:51:54,320 --> 00:51:54,560 ON -- 1448 00:51:54,560 --> 00:51:57,920 >> BEING ABLE TO LEVERAGE THAT 1449 00:51:57,920 --> 00:52:00,600 A.I. TECHNOLOGY AS WELL TO MAKE 1450 00:52:00,600 --> 00:52:01,040 THE INTERPRETATION. 1451 00:52:01,040 --> 00:52:02,200 >> MAY I TELL YOU SOMETHING, ONE 1452 00:52:02,200 --> 00:52:03,160 OF THE THINGS -- I WAS THE 1453 00:52:03,160 --> 00:52:04,560 PIONEER HERE IN PUERTO RICO, ONE 1454 00:52:04,560 --> 00:52:06,240 OF THE THINGS THAT I NEGOTIATED 1455 00:52:06,240 --> 00:52:09,520 WITH THE MEDICAL INSURANCE WAS 1456 00:52:09,520 --> 00:52:11,960 THAT I DO THE INTERPRETATION OF 1457 00:52:11,960 --> 00:52:14,080 MY WORK. 1458 00:52:14,080 --> 00:52:15,920 SO I GET PAID FOR THE 1459 00:52:15,920 --> 00:52:17,880 INTERPRETATION ON MY WORK, NOT 1460 00:52:17,880 --> 00:52:18,960 THE RADIOLOGIST. 1461 00:52:18,960 --> 00:52:21,240 SO I THINK THAT THERE IS, IN 1462 00:52:21,240 --> 00:52:23,880 TERMS OF WHAT YOU NEGOTIATE WITH 1463 00:52:23,880 --> 00:52:26,320 THE MEDICAL INSURANCE MORE THAN 1464 00:52:26,320 --> 00:52:28,160 POLICY. 1465 00:52:28,160 --> 00:52:29,760 THAT'S HAPPENED TO ME. 1466 00:52:29,760 --> 00:52:32,400 SO EACH THROMBECTOMY OR ANY 1467 00:52:32,400 --> 00:52:34,560 ENDOVASCULAR CASE THAT I DO, I 1468 00:52:34,560 --> 00:52:37,640 ALSO GET PAID FOR THE 1469 00:52:37,640 --> 00:52:38,280 INTERPRETATION TOO. 1470 00:52:38,280 --> 00:52:38,960 >> I THINK THAT'S COMMON. 1471 00:52:38,960 --> 00:52:39,880 I THINK WHAT WE'RE TALKING ABOUT 1472 00:52:39,880 --> 00:52:41,960 IS THE NONINVASIVE IMAGING, 1473 00:52:41,960 --> 00:52:43,360 WHERE YOU'RE INTERPRETING THE 1474 00:52:43,360 --> 00:52:44,880 CTP OR THE CTA. 1475 00:52:44,880 --> 00:52:47,000 >> OH, WELL, THAT'S -- 1476 00:52:47,000 --> 00:52:48,920 >> WHETHER YOU GET PAID OR NOT I 1477 00:52:48,920 --> 00:52:51,440 DON'T THINK IS AS IMPORTANT 1478 00:52:51,440 --> 00:52:52,840 BECAUSE YOU'RE COVERED IN THE 1479 00:52:52,840 --> 00:52:56,920 DRG, BUT BEING ABLE TO MAKE 1480 00:52:56,920 --> 00:52:57,560 INTERPRETATION AND NOT WAITING 1481 00:52:57,560 --> 00:53:00,840 FOR A NEURORADIOLOGIST 1482 00:53:00,840 --> 00:53:02,280 NECESSARILY OR EVEN IN THE 1483 00:53:02,280 --> 00:53:03,560 COMMUNITY, MANY PEOPLE 1484 00:53:03,560 --> 00:53:06,160 INTERPRETING ARE NOT TRAINED 1485 00:53:06,160 --> 00:53:07,200 NEURORADIOLOGISTS, THEY'RE 1486 00:53:07,200 --> 00:53:10,160 GENERAL RADIOLOGISTS. 1487 00:53:10,160 --> 00:53:11,440 >> JUSTIN? 1488 00:53:11,440 --> 00:53:13,520 >> MY UNDERSTANDING IN THE 1489 00:53:13,520 --> 00:53:15,360 THROMBECTOMY CODE 61645, THAT'S 1490 00:53:15,360 --> 00:53:16,760 BUNDLED WITH ANY DIAGNOSTIC 1491 00:53:16,760 --> 00:53:18,280 STUDIES YOU DO FOR THAT VESSEL. 1492 00:53:18,280 --> 00:53:21,880 SO UNLESS YOU'RE DOING OTHER 1493 00:53:21,880 --> 00:53:23,880 VESSELS OF A DSA FOR SOME OTHER 1494 00:53:23,880 --> 00:53:25,360 REASON, WHICH OFTEN IS NOT THE 1495 00:53:25,360 --> 00:53:27,680 CASE, RIGHT, WE JUST PULL THE 1496 00:53:27,680 --> 00:53:28,880 CLOT OUT AND WE'RE DONE, I DON'T 1497 00:53:28,880 --> 00:53:30,960 KNOW THAT WE CAN RELY ON DSA TO 1498 00:53:30,960 --> 00:53:31,960 MAKE UP OTHER COSTS. 1499 00:53:31,960 --> 00:53:35,000 I THINK IN MOST CASES WE'RE NOT 1500 00:53:35,000 --> 00:53:37,400 DOING FULL ANGIOS ON THESE 1501 00:53:37,400 --> 00:53:37,680 PATIENTS. 1502 00:53:37,680 --> 00:53:38,440 >> CORRECT. 1503 00:53:38,440 --> 00:53:39,160 I AGREE. 1504 00:53:39,160 --> 00:53:42,440 SOMEBODY HAD A HAND UP. 1505 00:53:42,440 --> 00:53:45,160 >> I DON'T SEE ANYBODY ELSE WITH 1506 00:53:45,160 --> 00:53:45,560 A HAND UP. 1507 00:53:45,560 --> 00:53:48,080 >> IT JUST WENT DOWN. 1508 00:53:48,080 --> 00:53:48,960 >> YEP. 1509 00:53:48,960 --> 00:53:49,400 ALL RIGHT. 1510 00:53:49,400 --> 00:53:50,400 EXCELLENT. 1511 00:53:50,400 --> 00:53:51,800 THANK YOU VERY MUCH, LEE AND 1512 00:53:51,800 --> 00:53:52,040 OTHERS. 1513 00:53:52,040 --> 00:53:53,280 THIS WAS A VERY ROBUST 1514 00:53:53,280 --> 00:53:54,120 DISCUSSION. 1515 00:53:54,120 --> 00:53:57,600 I THINK WE CAPTURED SOME OF THE 1516 00:53:57,600 --> 00:53:58,280 KEY POINTS. 1517 00:53:58,280 --> 00:53:59,760 I THINK NEXT WE'RE GOING TO MOVE 1518 00:53:59,760 --> 00:54:03,760 ON TO THE INPATIENT CARE 1519 00:54:03,760 --> 00:54:04,800 DISCUSSION, AND I DON'T KNOW 1520 00:54:04,800 --> 00:54:06,160 WHETHER KAREN OR LARRY OR BOTH 1521 00:54:06,160 --> 00:54:09,360 ARE GOING TO BE DOING THAT? 1522 00:54:09,360 --> 00:54:10,520 >> THINK WE'RE GOING TO TAG TEAM 1523 00:54:10,520 --> 00:54:12,160 A LITTLE BIT BUT I'M GOING TO 1524 00:54:12,160 --> 00:54:12,920 START IT OFF. 1525 00:54:12,920 --> 00:54:15,200 IF YOU COULD GO TO THE NEXT 1526 00:54:15,200 --> 00:54:19,120 SLIDE. 1527 00:54:19,120 --> 00:54:20,960 SO I WITHOUT I WOULD START WITH 1528 00:54:20,960 --> 00:54:23,560 SOME GENERAWITH -- I THOUGHT I WOULD START 1529 00:54:23,560 --> 00:54:24,360 WITH GENERAL THOUGHTS THAT CAME 1530 00:54:24,360 --> 00:54:25,640 UP WITH THE DISCUSSION OF 1531 00:54:25,640 --> 00:54:27,240 INPATIENT CARE AND DISPARITIES 1532 00:54:27,240 --> 00:54:28,400 THROUGHOUT THE WHOLE SESSION 1533 00:54:28,400 --> 00:54:31,200 YESTERDAY. 1534 00:54:31,200 --> 00:54:33,320 INCLUDING SOME OF THE THEMES 1535 00:54:33,320 --> 00:54:36,480 HERE THAT CROSSED A LOT OF THE 1536 00:54:36,480 --> 00:54:39,560 SUBGROUPS, THE CROSS-CUTTING 1537 00:54:39,560 --> 00:54:40,680 THEMES, BREAKOUT SESSIONS AS 1538 00:54:40,680 --> 00:54:41,960 WELL. 1539 00:54:41,960 --> 00:54:44,560 SO FIRST OF ALL, I WOULD COMMENT 1540 00:54:44,560 --> 00:54:48,160 THAT DESPITE VERY EXTENSIVE 1541 00:54:48,160 --> 00:54:55,280 RESEARCH INTO THE LITERATURE 1542 00:54:55,280 --> 00:54:56,680 AND -- OUR OVERALL FINDING WAS 1543 00:54:56,680 --> 00:54:58,160 THERE WAS SURPRISINGLY LITTLE 1544 00:54:58,160 --> 00:54:59,400 KNOWN ABOUT DISPARITIES IN 1545 00:54:59,400 --> 00:55:01,360 INPATIENT CARE, AND I'M NOT SURE 1546 00:55:01,360 --> 00:55:03,240 WHY THAT IS, BUT IT HASN'T BEEN 1547 00:55:03,240 --> 00:55:06,760 REALLY AS WELL STUDIED AS OTHER 1548 00:55:06,760 --> 00:55:08,480 ASPECTS THAT WE'RE TALKING ABOUT 1549 00:55:08,480 --> 00:55:09,440 TODAY. 1550 00:55:09,440 --> 00:55:11,000 THE INFORMATION WE DID FIND 1551 00:55:11,000 --> 00:55:13,320 PRIMARILY HAD TO DO WITH 1552 00:55:13,320 --> 00:55:14,520 ANTI-PLATELET AGENTS, 1553 00:55:14,520 --> 00:55:16,120 ANTICOAGULANTS AND STATINS, BUT 1554 00:55:16,120 --> 00:55:17,280 THERE WAS VERY LITTLE WE COULD 1555 00:55:17,280 --> 00:55:20,040 FIND ON DIAGNOSTIC TESTING AND 1556 00:55:20,040 --> 00:55:21,440 PROCEDURES, AND I THINK SOME OF 1557 00:55:21,440 --> 00:55:23,360 THE DISCUSSION YESTERDAY CENTER 1558 00:55:23,360 --> 00:55:24,600 ON WHAT WE COULD DO ABOUT THAT 1559 00:55:24,600 --> 00:55:27,160 AND HOW WE COULD USE INFORMATION 1560 00:55:27,160 --> 00:55:28,640 THAT'S ALREADY OUT THERE, SUCH 1561 00:55:28,640 --> 00:55:32,160 AS WHAT'S AVAILABLE IN THE 1562 00:55:32,160 --> 00:55:33,360 ELECTRONIC RECORD, BIG DATABASES 1563 00:55:33,360 --> 00:55:34,880 SUCH AS THE GET WITH THE 1564 00:55:34,880 --> 00:55:36,960 GUIDELINES DATABASE, WHERE THERE 1565 00:55:36,960 --> 00:55:40,360 ARE OPPORTUNITIES FOR PERHAPS 1566 00:55:40,360 --> 00:55:41,760 MINING DATA WITH REGARD TO 1567 00:55:41,760 --> 00:55:44,960 DISPARITIES IN INPATIENT CARE 1568 00:55:44,960 --> 00:55:47,160 THAT WE HAVEN'T REALLY LOOKED 1569 00:55:47,160 --> 00:55:48,440 AT, AND THERE PROBABLY ARE 1570 00:55:48,440 --> 00:55:51,080 SIGNIFICANT BARRIERS TO THAT, 1571 00:55:51,080 --> 00:55:53,360 BUT PROBABLY DESERVES FURTHER 1572 00:55:53,360 --> 00:55:54,640 ATTENTION AS TO HOW WE CAN GET 1573 00:55:54,640 --> 00:55:56,200 AT SOME OF THESE ISSUES THROUGH 1574 00:55:56,200 --> 00:55:59,160 SOME OF THE EXISTING DATA THAT 1575 00:55:59,160 --> 00:56:00,440 IS UNIQUELY AVAILABLE FOR 1576 00:56:00,440 --> 00:56:03,160 INPATIENT CARE. 1577 00:56:03,160 --> 00:56:05,320 THERE WAS THE DISCUSSION OF 1578 00:56:05,320 --> 00:56:06,920 TRYING TO MOVE FROM ASSOCIATION 1579 00:56:06,920 --> 00:56:08,320 TO CAUSATION, WHICH I THINK 1580 00:56:08,320 --> 00:56:09,640 WE'RE ALL IN FAVOR. 1581 00:56:09,640 --> 00:56:11,280 WE NEED TO GET TO THE BOTTOM OF 1582 00:56:11,280 --> 00:56:12,800 NOT JUST WHAT THOSE DISPARITIES 1583 00:56:12,800 --> 00:56:17,360 ARE, BUT WHY THEY ARE. 1584 00:56:17,360 --> 00:56:19,560 AS OTHERS HAVE MENTIONED 1585 00:56:19,560 --> 00:56:21,960 ALREADY, THIS ISSUE OF 1586 00:56:21,960 --> 00:56:24,680 POST-ACUTE CARE AND REHAB IS AN 1587 00:56:24,680 --> 00:56:25,120 IMPORTANT ONE. 1588 00:56:25,120 --> 00:56:27,760 WE KIND OF INTEGRATED INTO THIS 1589 00:56:27,760 --> 00:56:30,600 INPATIENT CARE, AND I THINK LEE 1590 00:56:30,600 --> 00:56:33,400 MENTIONED THAT HER GROUP ALSO 1591 00:56:33,400 --> 00:56:35,720 TALKED SOME ABOUT THAT, BUT THIS 1592 00:56:35,720 --> 00:56:39,880 IS AN IMPORTANT AREA AND MAYBE 1593 00:56:39,880 --> 00:56:40,520 GOING FORWARD SHOULD BE A 1594 00:56:40,520 --> 00:56:41,720 SEPARATE AREA OF STUDY. 1595 00:56:41,720 --> 00:56:44,680 THE DISCONNECTION BETWEEN WHAT 1596 00:56:44,680 --> 00:56:47,520 GOES ON IN THE HOSPITAL AND 1597 00:56:47,520 --> 00:56:48,520 POST-HOSPITAL CARE IS, I THINK, 1598 00:56:48,520 --> 00:56:51,920 AN AREA THAT IS PROBLEMATIC AND 1599 00:56:51,920 --> 00:56:53,400 PROBABLY CONTRIBUTES TO 1600 00:56:53,400 --> 00:56:54,800 DISPARITIES. 1601 00:56:54,800 --> 00:56:57,160 AND SO TO THE EXTENT THAT WE CAN 1602 00:56:57,160 --> 00:56:58,320 INTEGRATE THOSE THINGS AND 1603 00:56:58,320 --> 00:57:00,160 PROBABLY WITH PRE-HOSPITAL CARE 1604 00:57:00,160 --> 00:57:03,360 AS WELL, INTO A COHERENT SYSTEM 1605 00:57:03,360 --> 00:57:06,640 WOULD CERTAINLY HELP THIS 1606 00:57:06,640 --> 00:57:06,920 SITUATION. 1607 00:57:06,920 --> 00:57:07,840 ONE OTHER THING THAT WAS 1608 00:57:07,840 --> 00:57:10,240 MENTIONED WAS TRYING TO ADDRESS 1609 00:57:10,240 --> 00:57:13,400 THESE SOCIAL FACTORS FOR 1610 00:57:13,400 --> 00:57:15,920 PATIENTS BEFORE DISCHARGE RATHER 1611 00:57:15,920 --> 00:57:17,360 THAN TRYING TO DEAL WITH THEM 1612 00:57:17,360 --> 00:57:18,800 AFTERWARDS WOULD BE A 1613 00:57:18,800 --> 00:57:20,360 CONTRIBUTION AND, I BELIEVE, I 1614 00:57:20,360 --> 00:57:21,680 THINK IT WAS MEDSTAR THAT 1615 00:57:21,680 --> 00:57:22,560 MENTIONED THEY'RE ALREADY DOING 1616 00:57:22,560 --> 00:57:25,720 THIS, AND I THINK THAT'S A GREAT 1617 00:57:25,720 --> 00:57:26,040 SUGGESTION. 1618 00:57:26,040 --> 00:57:29,160 MARK, YOU MENTIONED THE IDEA OF 1619 00:57:29,160 --> 00:57:31,120 MAYBE ALLOWING SHORTER INPATIENT 1620 00:57:31,120 --> 00:57:35,680 REHAB STAYS TO REDUCE COSTS AND 1621 00:57:35,680 --> 00:57:36,680 THAT WOULD BE A POSSIBILITY AS 1622 00:57:36,680 --> 00:57:37,960 WELL. 1623 00:57:37,960 --> 00:57:40,280 SOME OF THE THINGS THAT CROSSED 1624 00:57:40,280 --> 00:57:43,080 OUR BREAKOUT SESSIONS IN TERMS 1625 00:57:43,080 --> 00:57:45,520 OF THEMES, TELEMEDICINE SEEMS TO 1626 00:57:45,520 --> 00:57:47,440 AB THEME THAT CROSSES EVERYTHING 1627 00:57:47,440 --> 00:57:49,480 HERE AND CERTAINLY OUR INPATIENT 1628 00:57:49,480 --> 00:57:51,600 CARE AREA WAS NO EXCEPTION. 1629 00:57:51,600 --> 00:57:54,560 PARTICULARLY WITH REGARD TO 1630 00:57:54,560 --> 00:57:55,760 REHABILITATION THERAPY 1631 00:57:55,760 --> 00:57:57,840 POST-ACUTE CARE, WHERE THERE ARE 1632 00:57:57,840 --> 00:57:58,720 CLEAR DISPARITIES IN TERMS OF 1633 00:57:58,720 --> 00:58:00,480 THE UTILIZATION OF INPATIENT 1634 00:58:00,480 --> 00:58:04,840 REHAB VERSUS HOME HEALTH VERSUS 1635 00:58:04,840 --> 00:58:06,560 SNFs AND THE ABILITY TO 1636 00:58:06,560 --> 00:58:11,800 DELIVERY HA REHAB IN THE HOME 1637 00:58:11,800 --> 00:58:12,680 THROUGH TELEMEDICINE, WHICH IS 1638 00:58:12,680 --> 00:58:15,200 POSSIBLE AND THERE ARE ALREADY 1639 00:58:15,200 --> 00:58:16,560 RANDOMIZED CONTROL TRIALS SHOW 1640 00:58:16,560 --> 00:58:18,560 THAT THIS IS JUST AS EFFECTIVE 1641 00:58:18,560 --> 00:58:19,840 AS IN-PERSON REHAB WOULD 1642 00:58:19,840 --> 00:58:21,400 CERTAINLY BE A CONTRIBUTION. 1643 00:58:21,400 --> 00:58:22,480 FINALLY, WE TALKED A LOT ABOUT 1644 00:58:22,480 --> 00:58:25,200 THE FACT THAT IN REVIEWING THE 1645 00:58:25,200 --> 00:58:26,400 LITERATURE, THERE WERE LOTS OF 1646 00:58:26,400 --> 00:58:28,480 DIFFERENT DEFINITIONS AND THERE 1647 00:58:28,480 --> 00:58:31,080 WAS DIFFERENT TERMINOLOGY USED 1648 00:58:31,080 --> 00:58:32,560 IN DIFFERENT STUDIES AND 1649 00:58:32,560 --> 00:58:34,960 DIFFERENT WAYS, AND TO THE 1650 00:58:34,960 --> 00:58:36,560 EXTENT THAT WE COULD STANDARDIZE 1651 00:58:36,560 --> 00:58:39,320 THINGS, IT WOULD REALLY HELP US 1652 00:58:39,320 --> 00:58:41,080 NOT ONLY BRINGING TOGETHER SOME 1653 00:58:41,080 --> 00:58:42,800 OF THE PREVIOUS LITERATURE BUT 1654 00:58:42,800 --> 00:58:44,000 GOING FORWARD, AS PEOPLE 1655 00:58:44,000 --> 00:58:45,440 CONTINUE TO STUDY THIS, AND I'M 1656 00:58:45,440 --> 00:58:47,520 SURE THAT WILL OCCUR, THAT WE'RE 1657 00:58:47,520 --> 00:58:48,520 ALL TALKING ABOUT THE SAME 1658 00:58:48,520 --> 00:58:50,760 THINGS AND WE CAN PULL THINGS 1659 00:58:50,760 --> 00:58:52,200 TOGETHER BY THIS KIND OF 1660 00:58:52,200 --> 00:58:54,840 STANDARDIZATION. 1661 00:58:54,840 --> 00:58:56,240 SO NOW I'LL TURN IT OVER TO 1662 00:58:56,240 --> 00:58:57,680 KAREN FOR DISCUSSION OF THE 1663 00:58:57,680 --> 00:59:00,640 INDIVIDUAL BREAKOUT ROOMS. 1664 00:59:00,640 --> 00:59:01,640 >> THANKS, LARRY. 1665 00:59:01,640 --> 00:59:05,120 THAT WAS A TREMENDOUS OVERVIEW. 1666 00:59:05,120 --> 00:59:06,200 LET ME JUST TALK ABOUT THE 1667 00:59:06,200 --> 00:59:07,280 INDIVIDUAL BREAKOUT SESSIONS. 1668 00:59:07,280 --> 00:59:09,040 THE FIRST WAS FOCUSED ON 1669 00:59:09,040 --> 00:59:11,440 DEMOGRAPHICS. 1670 00:59:11,440 --> 00:59:15,800 AND IT'S VERY CLEAR THAT IT 1671 00:59:15,800 --> 00:59:18,320 IMPOSSIBLE TO SEPARATE 1672 00:59:18,320 --> 00:59:20,600 DEMOGRAPHICS FROM OTHER FACTORS 1673 00:59:20,600 --> 00:59:24,200 LIKE GEOGRAPHY OR SOCIOECONOMIC 1674 00:59:24,200 --> 00:59:25,560 STATUS. 1675 00:59:25,560 --> 00:59:28,360 AND SO IT'S IMPORTANT MOVING 1676 00:59:28,360 --> 00:59:29,760 FORWARD TO TRY AND LOOK AT 1677 00:59:29,760 --> 00:59:32,400 MULTIPLE ELEMENTS AND TEASE OUT 1678 00:59:32,400 --> 00:59:34,600 THE ACTUAL CAUSAL FACTORS THAT 1679 00:59:34,600 --> 00:59:37,360 ARE CONTRIBUTING TO INEQUITIES. 1680 00:59:37,360 --> 00:59:39,520 OVERALL, THERE SEEM TO BE A 1681 00:59:39,520 --> 00:59:42,040 CONSISTENT PATTERN THAT RURAL 1682 00:59:42,040 --> 00:59:44,200 AREAS WERE DISADVANTAGED, THAT 1683 00:59:44,200 --> 00:59:48,240 HAD TO DO WITH LESS 1684 00:59:48,240 --> 00:59:52,920 INFRASTRUCTURE, FEWER 1685 00:59:52,920 --> 00:59:53,960 PHYSICIANS, FEWER ACTUAL 1686 00:59:53,960 --> 00:59:55,680 INSTITUTIONS TO DELIVER CARE. 1687 00:59:55,680 --> 00:59:58,960 A COMMENT WAS MADE THAT THERE IS 1688 00:59:58,960 --> 01:00:01,360 NO REHAB HOSPITAL IN THE STATE 1689 01:00:01,360 --> 01:00:02,560 OF NORTH DAKOTA, SO OBVIOUSLY IT 1690 01:00:02,560 --> 01:00:04,120 WOULD BE VERY CHALLENGING FOR 1691 01:00:04,120 --> 01:00:06,400 PATIENTS IN THAT REGION TO 1692 01:00:06,400 --> 01:00:09,240 ACTUALLY GET ACUTE INPATIENT 1693 01:00:09,240 --> 01:00:10,480 REHABILITATION. 1694 01:00:10,480 --> 01:00:13,720 RURAL AREAS MAY NOT HAVE THE 1695 01:00:13,720 --> 01:00:15,680 TECHNOLOGY OR THE CONNECTIONS 1696 01:00:15,680 --> 01:00:17,600 THAT THAT SILL TATE 1697 01:00:17,600 --> 01:00:18,040 TELEMEDICINE. 1698 01:00:18,040 --> 01:00:21,000 AS LARRY MENTIONED, PROVISION OF 1699 01:00:21,000 --> 01:00:23,840 TELESERVICES IS ONE WAY TO GET 1700 01:00:23,840 --> 01:00:26,240 EXPERTISE INTO REMOTE 1701 01:00:26,240 --> 01:00:28,680 COMMUNITIES. 1702 01:00:28,680 --> 01:00:30,160 POST-ACUTE CARE WAS VERY 1703 01:00:30,160 --> 01:00:34,560 CONSISTENTLY IDENTIFIED AS AN 1704 01:00:34,560 --> 01:00:35,960 AREA THAT REQUIRES GREATER 1705 01:00:35,960 --> 01:00:36,520 RESEARCH. 1706 01:00:36,520 --> 01:00:39,760 THE TRANSITION OF CARE, THE 1707 01:00:39,760 --> 01:00:41,200 SELECTION OF THE POST-ACUTE CARE 1708 01:00:41,200 --> 01:00:44,280 SETTING MAY INVOLVE INEQUITIES 1709 01:00:44,280 --> 01:00:49,160 BASED ON INSURANCE ACCESS, AND 1710 01:00:49,160 --> 01:00:52,800 THERE ARE NO STANDARDS FOR 1711 01:00:52,800 --> 01:00:55,680 INDIVIDUALS ACTUALLY MEETING THE 1712 01:00:55,680 --> 01:00:58,040 BAR FOR INPATIENT ACUTE 1713 01:00:58,040 --> 01:00:59,760 REHABILITATION THAT ARE 1714 01:00:59,760 --> 01:01:01,200 CONSISTENT ACROSS THE COUNTRY 1715 01:01:01,200 --> 01:01:05,160 AND ACROSS SYSTEMS. 1716 01:01:05,160 --> 01:01:07,880 INTERVENTIONS ARE TEAM-BASED AND 1717 01:01:07,880 --> 01:01:09,600 MULTIFACTORIAL, AND TO THE 1718 01:01:09,600 --> 01:01:12,000 EXTENT THAT THOSE TEAMS EXIST 1719 01:01:12,000 --> 01:01:16,000 AND ARE POPULATED BY A DIVERSE 1720 01:01:16,000 --> 01:01:17,560 WORKFORCE, THERE MAY BE 1721 01:01:17,560 --> 01:01:23,880 IMPROVEMENTS IN DELIVERING CARE 1722 01:01:23,880 --> 01:01:26,760 TO PEOPLE -- RACE, ETHNIC AND 1723 01:01:26,760 --> 01:01:28,720 AGE CATEGORIES. 1724 01:01:28,720 --> 01:01:32,840 STANDARDIZATION OF CARE ENABLES 1725 01:01:32,840 --> 01:01:35,680 INDIVIDUALS TO ELIMINATE BIAS. 1726 01:01:35,680 --> 01:01:38,200 SO PHYSICIANS WHO FOLLOW 1727 01:01:38,200 --> 01:01:40,840 ALGORITHMS OR PROTOCOLS STILL 1728 01:01:40,840 --> 01:01:43,160 HAVE THE ABILITY TO MODIFY CARE 1729 01:01:43,160 --> 01:01:45,200 FOR THE INDIVIDUAL, BUT FOR THE 1730 01:01:45,200 --> 01:01:48,480 MOST PART, IT ALLOWS OBJECTIVE 1731 01:01:48,480 --> 01:01:51,200 EVALUATION OF WHETHER THERE'S 1732 01:01:51,200 --> 01:01:52,760 CONSISTENT APPLICATION OF 1733 01:01:52,760 --> 01:01:54,360 DIAGNOSTIC AND THERAPEUTIC 1734 01:01:54,360 --> 01:01:57,880 ALGORITHMS. 1735 01:01:57,880 --> 01:02:01,280 IN TERMS OF ECONOMICS, AGAIN, WE 1736 01:02:01,280 --> 01:02:02,920 FOUND GREATEST EVIDENCE OF 1737 01:02:02,920 --> 01:02:05,400 DISPARITIES IN POST-ACUTE CARE. 1738 01:02:05,400 --> 01:02:07,480 THE PROVISION OF INPATIENT 1739 01:02:07,480 --> 01:02:08,680 REHABILITATION VERSUS HOME 1740 01:02:08,680 --> 01:02:10,360 HEALTH VERSUS SKILLED NURSING 1741 01:02:10,360 --> 01:02:14,480 FACILITIES DID VARY BY AGE, SEX, 1742 01:02:14,480 --> 01:02:17,160 AND RACIAL GROUPS. 1743 01:02:17,160 --> 01:02:18,720 IT'S UNCLEAR TO WHAT EXTENT 1744 01:02:18,720 --> 01:02:21,440 THESE DIFFERENCES IMPACT 1745 01:02:21,440 --> 01:02:23,520 RECOVERY, MORTALITY, AND 1746 01:02:23,520 --> 01:02:26,360 SECONDARY STROKE PREVENTION 1747 01:02:26,360 --> 01:02:29,600 INTERVENTIONS LIKE IMPLANTABLE 1748 01:02:29,600 --> 01:02:34,440 LOOP MONITORS FOR ATRIAL 1749 01:02:34,440 --> 01:02:34,760 FIBRILLATION. 1750 01:02:34,760 --> 01:02:36,480 IT IMPORTANT TO NOTE THAT THE 1751 01:02:36,480 --> 01:02:37,600 SOCIAL DETERMINANTS OF HEALTH 1752 01:02:37,600 --> 01:02:40,760 ENCOMPASS NOT ONLY FAMILY 1753 01:02:40,760 --> 01:02:42,840 INCOME, BUT ALSO THE FAMILIAR 1754 01:02:42,840 --> 01:02:44,600 DYNAMICS AND INSURANCE, AND ALL 1755 01:02:44,600 --> 01:02:48,720 OF THESE IMPACT THE DYNAMIC OF 1756 01:02:48,720 --> 01:02:50,520 THE ACUTE INPATIENT 1757 01:02:50,520 --> 01:02:52,160 HOSPITALIZATION AND DELIVERY OF 1758 01:02:52,160 --> 01:02:55,440 POST-ACUTE CARE. 1759 01:02:55,440 --> 01:02:58,400 THERE'S VERY LITTLE DATA 1760 01:02:58,400 --> 01:03:01,360 AVAILABLE IN THIS AREA, AND WE 1761 01:03:01,360 --> 01:03:03,440 FELT THAT THERE NEEDED TO BE 1762 01:03:03,440 --> 01:03:06,840 HYPOTHESIS-DRIVEN RESEARCH TO 1763 01:03:06,840 --> 01:03:08,360 ASSESS INTERVENTIONS AND ADDRESS 1764 01:03:08,360 --> 01:03:17,360 SOME OF THESE IMPORTANT ISSUES. 1765 01:03:17,360 --> 01:03:19,040 POLICY AND REGULATIONS. 1766 01:03:19,040 --> 01:03:20,880 WE LOOK TO SEE WHETHER THERE 1767 01:03:20,880 --> 01:03:26,120 MIGHT BE OPPORTUNITIES FOR 1768 01:03:26,120 --> 01:03:27,760 EVALUATING AND ACCREDITING 1769 01:03:27,760 --> 01:03:28,640 AGENCIES SUCH AS THE JOINT 1770 01:03:28,640 --> 01:03:33,240 COMMISSION TO EVALUATE 1771 01:03:33,240 --> 01:03:34,360 DISPARITIES AND INCORPORATE IT 1772 01:03:34,360 --> 01:03:38,680 INTO THE CERTIFICATION PROCESS. 1773 01:03:38,680 --> 01:03:40,440 MANY OF THESE DATA ARE READILY 1774 01:03:40,440 --> 01:03:42,520 AVAILABLE THROUGH ELECTRONIC 1775 01:03:42,520 --> 01:03:43,960 MEDICAL RECORDS, BUT INCLUDING 1776 01:03:43,960 --> 01:03:46,440 THIS IN THE CERTIFICATION 1777 01:03:46,440 --> 01:03:48,200 PROCESS WOULD ALLOW 1778 01:03:48,200 --> 01:03:50,160 IDENTIFICATION OF DISPARITY AND 1779 01:03:50,160 --> 01:03:51,040 PERHAPS IDENTIFY AREAS FOR 1780 01:03:51,040 --> 01:03:55,160 FUTURE RESEARCH. 1781 01:03:55,160 --> 01:03:58,240 THERE'S AN EXTENSIVE LITERATURE 1782 01:03:58,240 --> 01:04:02,840 THAT INDICATES THAT THE USE OF A 1783 01:04:02,840 --> 01:04:06,600 HOSPITAL STLOAK UNI STROKE UNIT IMPROVES 1784 01:04:06,600 --> 01:04:08,200 CARE AND OUTCOMES, BUT THIS HAS 1785 01:04:08,200 --> 01:04:09,400 NOT BEEN EVALUATED IN THE 1786 01:04:09,400 --> 01:04:10,600 CONTEXT OF A SPOKE AND HUB 1787 01:04:10,600 --> 01:04:14,560 MODEL. 1788 01:04:14,560 --> 01:04:18,200 APPLICATION OF COMMON ORDER SETS 1789 01:04:18,200 --> 01:04:20,280 AND EVIDENCE-BASED PATHWAYS CAN 1790 01:04:20,280 --> 01:04:21,240 STANDARDIZE CARE ACROSS 1791 01:04:21,240 --> 01:04:25,840 DIFFERENT RURAL AND COMMUNITY 1792 01:04:25,840 --> 01:04:26,400 HOSPITALS. 1793 01:04:26,400 --> 01:04:27,960 TELEHEALTH CAN SUPPORT NOT ONLY 1794 01:04:27,960 --> 01:04:30,560 EMERGENCY DEPARTMENT CARE, BUT 1795 01:04:30,560 --> 01:04:33,160 ALSO HELP STANDARDIZE AND 1796 01:04:33,160 --> 01:04:36,120 OPTIMIZE MANAGEMENT DURING THE 1797 01:04:36,120 --> 01:04:38,640 INPATIENT HOSPITALIZATION. 1798 01:04:38,640 --> 01:04:40,280 COST AND REIMBURSEMENT 1799 01:04:40,280 --> 01:04:41,760 LIMITATIONS DO CREATE 1800 01:04:41,760 --> 01:04:44,120 DISPARITIES IN RURAL AND REMOTE 1801 01:04:44,120 --> 01:04:44,320 AREAS. 1802 01:04:44,320 --> 01:04:45,960 AND THIS SHOULD BE EVALUATED AND 1803 01:04:45,960 --> 01:04:48,560 PERHAPS ADDRESSED BY MORE FORMAL 1804 01:04:48,560 --> 01:04:54,600 STATE AND FEDERAL POLICIES. 1805 01:04:54,600 --> 01:04:58,760 IN TERMS OF GEOGRAPHY, AGAIN, 1806 01:04:58,760 --> 01:05:09,560 THERE'S AN EMESHMENT, THERE'S AN 1807 01:05:09,560 --> 01:05:12,400 IMPEDIMENT TO UNDERSTANDING 1808 01:05:12,400 --> 01:05:14,360 CONTRIBUTORS TO DELIVERIES AND 1809 01:05:14,360 --> 01:05:15,160 INEQUITIES OF CARE. 1810 01:05:15,160 --> 01:05:16,200 ACROSS THE UNITED STATES, THERE 1811 01:05:16,200 --> 01:05:18,160 ARE CERTAINLY AREAS THAT ARE 1812 01:05:18,160 --> 01:05:20,360 ENRICHED WITH NEUROLOGICAL AND 1813 01:05:20,360 --> 01:05:22,640 IN PARTICULAR STROKE EXPERTISE, 1814 01:05:22,640 --> 01:05:24,720 BUT OTHER AREAS WHERE THIS MIGHT 1815 01:05:24,720 --> 01:05:27,440 NOT BE AVAILABLE FOR AN ENTIRE 1816 01:05:27,440 --> 01:05:28,720 REGION. 1817 01:05:28,720 --> 01:05:29,840 TELESTROKE IS ONE WAY TO HELP 1818 01:05:29,840 --> 01:05:34,000 ADDRESS THIS. 1819 01:05:34,000 --> 01:05:37,520 SECONDARY STROKE PREVENTION IS 1820 01:05:37,520 --> 01:05:40,440 OBVIOUSLY CRITICAL TO LONG-TERM 1821 01:05:40,440 --> 01:05:42,080 OUTCOMES TO HELP PREVENT 1822 01:05:42,080 --> 01:05:43,600 RECURRENT STROKE AND VASCULAR 1823 01:05:43,600 --> 01:05:45,240 COGNITIVE IMPAIRMENT. 1824 01:05:45,240 --> 01:05:50,960 BUT IT'S UNCLEAR TO WHAT EXTENT 1825 01:05:50,960 --> 01:05:52,360 TRANSITIONS OF CARE AND 1826 01:05:52,360 --> 01:05:53,880 CONTINUED SUPPORT OF SECONDARY 1827 01:05:53,880 --> 01:05:55,160 STROKE PREVENTION ARE AVAILABLE 1828 01:05:55,160 --> 01:05:58,800 IN THE COMMUNITY. 1829 01:05:58,800 --> 01:06:00,000 DEVELOPING PATIENT 1830 01:06:00,000 --> 01:06:01,760 SELF-MANAGEMENT TOOLS MAY HELP 1831 01:06:01,760 --> 01:06:03,160 EMPOWER PATIENTS AND STANDARDIZE 1832 01:06:03,160 --> 01:06:06,880 THIS PRACTICE ACROSS THE UNITED 1833 01:06:06,880 --> 01:06:07,120 STATES. 1834 01:06:07,120 --> 01:06:10,720 AND THEN FINALLY A VERY 1835 01:06:10,720 --> 01:06:12,240 CONSISTENT THEME WAS THE LACK OF 1836 01:06:12,240 --> 01:06:16,760 AVAILABILITY OF INPATIENT REHAB 1837 01:06:16,760 --> 01:06:19,600 BY REGION, AND PATIENTS MAY NOT 1838 01:06:19,600 --> 01:06:21,360 BE WILLING TO BE HOURS AWAY FROM 1839 01:06:21,360 --> 01:06:23,240 THEIR FAMILIES AND MAY CHOOSE 1840 01:06:23,240 --> 01:06:26,160 NOT TO GO FOR INPATIENT 1841 01:06:26,160 --> 01:06:30,680 REHABILITATION CARE AS A RESULT. 1842 01:06:30,680 --> 01:06:32,160 SO THERE ARE MANY OUTSTANDING 1843 01:06:32,160 --> 01:06:35,920 QUESTIONS AND GAPS. 1844 01:06:35,920 --> 01:06:37,320 ADDITIONAL RESEARCH IS NEEDED TO 1845 01:06:37,320 --> 01:06:40,360 ACTUALLY EXPLORE DISPARITIES IN 1846 01:06:40,360 --> 01:06:44,800 MODERN UTILIZATION OF IMAGE IMAGING 1847 01:06:44,800 --> 01:06:45,160 AND PROCEDURES. 1848 01:06:45,160 --> 01:06:46,600 I WANT TO THANK GLEN FOR 1849 01:06:46,600 --> 01:06:49,000 FORWARDING ME A MANUSCRIPT FROM 1850 01:06:49,000 --> 01:06:52,640 2003 THAT WAS PUBLISHED IN 1851 01:06:52,640 --> 01:06:52,880 STROKE. 1852 01:06:52,880 --> 01:06:53,920 IT CAME UP IN THE DISCUSSION 1853 01:06:53,920 --> 01:06:58,640 YESTERDAY THAT THE V.A. SYSTEM 1854 01:06:58,640 --> 01:07:02,240 PROVIDES A VERY NICE CAPACITY 1855 01:07:02,240 --> 01:07:03,240 FOR EVALUATING THE APPLICATION 1856 01:07:03,240 --> 01:07:06,080 OF BOTH TESTING AND PROCEDURES, 1857 01:07:06,080 --> 01:07:08,920 AND LARRY GOLDSTEIN WAS THE 1858 01:07:08,920 --> 01:07:09,760 FIRST AUTHOR ON THE MANUSCRIPT 1859 01:07:09,760 --> 01:07:12,400 THAT LOOKED AT THIS 1860 01:07:12,400 --> 01:07:12,960 RETROSPECTIVELY. 1861 01:07:12,960 --> 01:07:14,000 ALTHOUGH IT COVERED MANY OF THE 1862 01:07:14,000 --> 01:07:16,080 AREAS THAT ARE OF INTEREST EVEN 1863 01:07:16,080 --> 01:07:21,560 TODAY, SUCH AS USE OF C.T., CTA, 1864 01:07:21,560 --> 01:07:23,320 MRI, CAROTID ULTRASOUND AND 1865 01:07:23,320 --> 01:07:26,160 PROCEDURES SUCH AS CAROTID 1866 01:07:26,160 --> 01:07:26,680 ENDARTERECTOMY. 1867 01:07:26,680 --> 01:07:30,080 THE DATA USED IN THAT STUDY WAS 1868 01:07:30,080 --> 01:07:34,880 FROM 1995 TO 1997, SO QUITE 1869 01:07:34,880 --> 01:07:36,520 DATED AT THIS POINT IN TIME, AND 1870 01:07:36,520 --> 01:07:39,120 IT ONLY INVOLVED DATA FROM THE 1871 01:07:39,120 --> 01:07:40,240 VA SYSTEM, WHICH INTRODUCES SOME 1872 01:07:40,240 --> 01:07:41,120 BIAS. 1873 01:07:41,120 --> 01:07:43,840 SO READDRESSING THIS IN A MORE 1874 01:07:43,840 --> 01:07:47,560 COMPREHENSIVE MANNER IN 2022 AND 1875 01:07:47,560 --> 01:07:49,760 MOVING FORWARD WILL BE VERY 1876 01:07:49,760 --> 01:07:51,800 IMPORTANT TO UNDERSTAND WHETHER 1877 01:07:51,800 --> 01:07:54,360 INEQUITIES EXIST. 1878 01:07:54,360 --> 01:07:57,280 WE NEED TO FURTHER EXPLORE THE 1879 01:07:57,280 --> 01:07:59,040 INTERACTIONS BETWEEN THE VARIOUS 1880 01:07:59,040 --> 01:08:01,960 FACTORS CONTRIBUTING TO 1881 01:08:01,960 --> 01:08:03,760 DISPARITIES, GEOGRAPHY, 1882 01:08:03,760 --> 01:08:06,920 SOCIOECONOMIC STATUS, AND 1883 01:08:06,920 --> 01:08:08,120 DEMOGRAPHICS NEED TO BE BETTER 1884 01:08:08,120 --> 01:08:10,480 TEASED OUT. 1885 01:08:10,480 --> 01:08:13,000 TELEMEDICINE WAS A CONSISTENT 1886 01:08:13,000 --> 01:08:13,880 POTENTIAL SOLUTION FOR 1887 01:08:13,880 --> 01:08:16,280 SUPPORTING CARE ACROSS MANY 1888 01:08:16,280 --> 01:08:18,560 DIFFERENT EPOCHS OF STROKE CARE, 1889 01:08:18,560 --> 01:08:22,280 AND IT HAS REALLY BEEN 1890 01:08:22,280 --> 01:08:23,240 UNDEREVALUATED IN THE 1891 01:08:23,240 --> 01:08:24,680 IN-HOSPITAL STROKE SETTING. 1892 01:08:24,680 --> 01:08:26,520 AND THEN FINALLY, COST AND 1893 01:08:26,520 --> 01:08:28,360 REIMBURSEMENT ISSUES ASSOCIATED 1894 01:08:28,360 --> 01:08:30,880 WITH INPATIENT AND POST 1895 01:08:30,880 --> 01:08:32,200 DISCHARGE COMPLIANCE NEEDS TO BE 1896 01:08:32,200 --> 01:08:33,080 BETTER DEFINED. 1897 01:08:33,080 --> 01:08:34,640 FLAWCIAL THANK YOU, AND I'LL 1898 01:08:34,640 --> 01:08:38,960 TURN THITHANK YOU, AND I'LL TURN THISBACK OVER TO LARRY. 1899 01:08:38,960 --> 01:08:39,840 >> THANKS, KAREN. 1900 01:08:39,840 --> 01:08:43,160 SO WE PUT TOGETHER SOME KIND OF 1901 01:08:43,160 --> 01:08:44,880 OVERREACHING SUGGESTIONS FOR 1902 01:08:44,880 --> 01:08:46,640 BEST PRACTICES AND SOLUTIONS 1903 01:08:46,640 --> 01:08:49,800 BASED UPON THE BREAKOUT SESSIONS 1904 01:08:49,800 --> 01:08:54,440 AND THE GENERAL DISCUSSIONS OF 1905 01:08:54,440 --> 01:08:57,120 THE INPATIENT TASK FORCE, AND 1906 01:08:57,120 --> 01:08:59,600 THEY'RE LISTED HERE. 1907 01:08:59,600 --> 01:09:01,960 SO FIRST, THIS CONCEPT OF 1908 01:09:01,960 --> 01:09:03,240 STANDARDIZATION OF PRACTICES 1909 01:09:03,240 --> 01:09:06,400 ACROSS HOSPITALS, NOT TO TRY TO 1910 01:09:06,400 --> 01:09:09,360 TAKE AWAY ANYONE'S INDEPENDENCE 1911 01:09:09,360 --> 01:09:13,520 OR ABILITY TO PERSONALIZED CARE, 1912 01:09:13,520 --> 01:09:17,440 BUT AT LEAST TO CREATE PATHWAYS 1913 01:09:17,440 --> 01:09:20,520 THAT ARE CONSISTENT AND GIVE 1914 01:09:20,520 --> 01:09:22,640 GUIDANCE TO PEOPLE AT HOSPITALS 1915 01:09:22,640 --> 01:09:23,880 THAT DON'T HAVE STROKE CENTERS 1916 01:09:23,880 --> 01:09:30,120 AND STROKE EXPERTISE, AND TO DO 1917 01:09:30,120 --> 01:09:31,200 THAT, THERE ARE SIMPLE WAYS THAT 1918 01:09:31,200 --> 01:09:32,960 THAT CAN BE ACCOMPLISHED BY 1919 01:09:32,960 --> 01:09:35,280 SHARING ORDER SETS AND PATHWAYS 1920 01:09:35,280 --> 01:09:39,320 AND PROVIDING TELEMEDICINE 1921 01:09:39,320 --> 01:09:40,600 SUPPORT. 1922 01:09:40,600 --> 01:09:43,120 LEE JENSEN ALSO MENTIONED FROM 1923 01:09:43,120 --> 01:09:46,280 HER GROUP THE IDEA OF THE HUB 1924 01:09:46,280 --> 01:09:48,040 AND SPOKE MODEL AND HOW THAT 1925 01:09:48,040 --> 01:09:51,960 COULD REDUCE DISPARITIES, AND I 1926 01:09:51,960 --> 01:09:53,720 THINK THAT OFTENTIMES WE HAVE 1927 01:09:53,720 --> 01:09:54,920 THE TELEMEDICINE COMPONENT OF A 1928 01:09:54,920 --> 01:09:57,440 HUB AND SPOKE NETWORK KIND OF 1929 01:09:57,440 --> 01:10:01,160 STOP AFTER THE EMERGENCY ROOM, 1930 01:10:01,160 --> 01:10:02,160 UPON ADMISSION TO THE HOSPITAL. 1931 01:10:02,160 --> 01:10:03,360 BUT THERE'S NO REASON WHY WE 1932 01:10:03,360 --> 01:10:05,960 CAN'T CONTINUE IT THROUGHOUT THE 1933 01:10:05,960 --> 01:10:08,960 INPATIENT STAY AS WELL AS IN THE 1934 01:10:08,960 --> 01:10:13,160 POST HOSPITAL SEGMENT TO HELP IN 1935 01:10:13,160 --> 01:10:16,400 THOSE SITUATIONS AS WELL. 1936 01:10:16,400 --> 01:10:17,600 BRINGING THE STROKE EXPERTISE TO 1937 01:10:17,600 --> 01:10:20,360 THE HOSPITAL FOR THINGS EVEN 1938 01:10:20,360 --> 01:10:21,680 BEYOND THE ACUTE DECISION-MAKING 1939 01:10:21,680 --> 01:10:25,040 IN THE EMERGENCY ROOM. 1940 01:10:25,040 --> 01:10:30,520 WE TALKED ABOUT THE FOCUS ON 1941 01:10:30,520 --> 01:10:30,960 CAUSATION RATHER THAN 1942 01:10:30,960 --> 01:10:31,280 ASSOCIATION. 1943 01:10:31,280 --> 01:10:32,560 I THINK THAT'S AN IMPORTANT STEP 1944 01:10:32,560 --> 01:10:34,200 WE NEED TO TAKE, EXACTLY HOW TO 1945 01:10:34,200 --> 01:10:38,160 DO THAT IS POSSIBLY A MORE 1946 01:10:38,160 --> 01:10:42,240 DIFFICULT ISSUE, BUT USING THE 1947 01:10:42,240 --> 01:10:43,120 DATA THAT'S ALREADY AVAILABLE 1948 01:10:43,120 --> 01:10:48,160 THROUGH THE EMR TO EXPLORE 1949 01:10:48,160 --> 01:10:49,160 DISPARITIES IN A NUMBER OF 1950 01:10:49,160 --> 01:10:51,720 DIFFERENT WAYS, T HOW TO MINE 1951 01:10:51,720 --> 01:10:53,000 THAT, HOW TO GET PAST THE 1952 01:10:53,000 --> 01:10:53,760 BARRIERS ARE SOMETHING THAT I 1953 01:10:53,760 --> 01:10:54,960 THINK WOULD BE IMPORTANT TO 1954 01:10:54,960 --> 01:10:56,400 INVESTIGATE BECAUSE THERE'S 1955 01:10:56,400 --> 01:10:57,920 PROBABLY A WEALTH OF INFORMATION 1956 01:10:57,920 --> 01:11:02,080 THERE THAT WE COULD USE. 1957 01:11:02,080 --> 01:11:03,720 KAREN MENTIONED THE IDEA OF THE 1958 01:11:03,720 --> 01:11:04,480 CERTIFICATION PROCESS, USING 1959 01:11:04,480 --> 01:11:09,080 THAT TO HELP US GET TO THAT DATA 1960 01:11:09,080 --> 01:11:12,360 BY IN SOME WAY REQUIRING 1961 01:11:12,360 --> 01:11:13,240 APPROPRIATE DATA COLLECTION THAT 1962 01:11:13,240 --> 01:11:14,560 MAY ALREADY BE THERE, BUT TO 1963 01:11:14,560 --> 01:11:18,960 MAKE IT AVAILABLE IN WAYS THAT 1964 01:11:18,960 --> 01:11:20,840 WE CAN ACCESS TO LOOK AT THESE 1965 01:11:20,840 --> 01:11:21,600 ISSUES OF DISPARITIES. 1966 01:11:21,600 --> 01:11:27,720 AND THEN THE TELEREHAB, WHICH IS 1967 01:11:27,720 --> 01:11:28,920 ONE AREA THAT OUR GROUP 1968 01:11:28,920 --> 01:11:30,000 CONSISTENTLY IDENTIFIED AS AN 1969 01:11:30,000 --> 01:11:34,280 AREA OF DISPARITIES WITH POST 1970 01:11:34,280 --> 01:11:38,640 HOSPITAL CARE AND THE USE OF 1971 01:11:38,640 --> 01:11:40,160 INPATIENT REHAB VERSUS HOME 1972 01:11:40,160 --> 01:11:42,560 HEALTH VERSUS SKILLED NURSING 1973 01:11:42,560 --> 01:11:44,480 AND SO ON, AND TELEREHAB IS A 1974 01:11:44,480 --> 01:11:48,480 WAY THAT WE MIGHT BE ABLE TO GET 1975 01:11:48,480 --> 01:11:51,120 PAST SOME OF THOSE ISSUES BY 1976 01:11:51,120 --> 01:11:51,760 DELIVERING REHABILITATION 1977 01:11:51,760 --> 01:11:55,800 THERAPY AT HOME. 1978 01:11:55,800 --> 01:11:57,200 SO THAT'S THE END OF OUR 1979 01:11:57,200 --> 01:11:58,160 PRESENTATION FOR OUR GROUP. 1980 01:11:58,160 --> 01:11:59,520 SO THANK YOU TO YOU AND TO 1981 01:11:59,520 --> 01:12:00,960 EVERYONE IN OUR GROUP FOR THEIR 1982 01:12:00,960 --> 01:12:04,880 GREAT PARTICIPATION. 1983 01:12:04,880 --> 01:12:06,640 >> THANK YOU, KAREN, THANK YOU, 1984 01:12:06,640 --> 01:12:07,280 LARRY. 1985 01:12:07,280 --> 01:12:09,000 GREAT DISCUSSION, GREAT SUM-UP. 1986 01:12:09,000 --> 01:12:12,520 LET'S OPEN THIS UP FOR COMMENTS, 1987 01:12:12,520 --> 01:12:16,520 SUGGESTIONS. 1988 01:12:16,520 --> 01:12:21,320 IDEAS. 1989 01:12:21,320 --> 01:12:22,640 LOOKING IN CHAT TO SEE IF 1990 01:12:22,640 --> 01:12:27,440 ANYBODY HAS THEIR HANDS UP. 1991 01:12:27,440 --> 01:12:31,720 KAREN AND LARRY, YOU ALL BOTH 1992 01:12:31,720 --> 01:12:32,680 MENTIONED SEVERAL TIMES, 1993 01:12:32,680 --> 01:12:34,120 RIGHTFULLY SO, THE ISSUE OF 1994 01:12:34,120 --> 01:12:35,320 STANDARDIZATION OF CARE AND 1995 01:12:35,320 --> 01:12:37,960 SHARING OORD SET ORDER SETS AND THINGS 1996 01:12:37,960 --> 01:12:38,720 LIKE THAT. 1997 01:12:38,720 --> 01:12:41,640 WHAT DO YOU THINK ARE BARRIERS 1998 01:12:41,640 --> 01:12:42,200 TO DO THAT? 1999 01:12:42,200 --> 01:12:44,800 I KNOW WITHIN HOSPITAL SYSTEMS, 2000 01:12:44,800 --> 01:12:46,760 HOPEFULLY THAT'S GOING ON 2001 01:12:46,760 --> 01:12:48,960 ROUTINELY, BUT HAVE YOU 2002 01:12:48,960 --> 01:12:50,280 IDENTIFIED OR EXPERIENCED 2003 01:12:50,280 --> 01:12:51,800 BARRIERS TO DO THAT WITHIN YOUR 2004 01:12:51,800 --> 01:12:59,840 STATE, YOUR SYSTEM, YOUR REGION? 2005 01:12:59,840 --> 01:13:02,360 I THINK IT'S 2006 01:13:02,360 --> 01:13:03,240 >> I HAVE NOT. 2007 01:13:03,240 --> 01:13:04,880 I THINK IT'S MORE GETTING 2008 01:13:04,880 --> 01:13:09,640 PEOPLE'S ATTENTION AND HOW 2009 01:13:09,640 --> 01:13:11,840 IMPORTANT IT IS WE ELIMINATE 2010 01:13:11,840 --> 01:13:12,760 INEQUITIES AND USE OF PROTOCOLS 2011 01:13:12,760 --> 01:13:14,480 THAT ARE EVIDENCE-BASED REALLY 2012 01:13:14,480 --> 01:13:16,040 HELPS THE HEALTHCARE SYSTEM 2013 01:13:16,040 --> 01:13:19,960 ACHIEVE THAT. 2014 01:13:19,960 --> 01:13:20,560 >> I AGREE. 2015 01:13:20,560 --> 01:13:22,120 I DON'T THINK PLACES WOULD BE 2016 01:13:22,120 --> 01:13:22,880 TERRIBLY RESISTANT TO IT. 2017 01:13:22,880 --> 01:13:26,560 I THINK IT'S MORE A MATTER OF 2018 01:13:26,560 --> 01:13:28,680 FOCUS THAT I THINK IN A LOT OF 2019 01:13:28,680 --> 01:13:30,200 HUB AND SPOKE TELESTROKENET 2020 01:13:30,200 --> 01:13:32,240 WORKS, FOR EXAMPLE, THE FOCUS 2021 01:13:32,240 --> 01:13:35,200 HAS BEEN ON DECISION ON 2022 01:13:35,200 --> 01:13:36,680 REPERFUSION THERAPY AND NOT 2023 01:13:36,680 --> 01:13:37,320 CONCENTRATING ON WHAT GOES ON 2024 01:13:37,320 --> 01:13:37,760 AFTER THAT. 2025 01:13:37,760 --> 01:13:39,280 I THINK IF WE COULD JUST CHANGE 2026 01:13:39,280 --> 01:13:44,960 THAT FOCUS AND CONTINUE THE 2027 01:13:44,960 --> 01:13:47,040 SUPPORT OF OUR SPOKE HOSPITALS 2028 01:13:47,040 --> 01:13:50,280 THROUGHOUT THE SPECTRUM OF NOT 2029 01:13:50,280 --> 01:13:52,800 ONLY E.D. AND ACUTE STROKE CARE 2030 01:13:52,800 --> 01:13:54,240 BUT HOSPITAL CARE, MAYBE EVEN 2031 01:13:54,240 --> 01:13:55,920 POST STROKE DISCHARGE, THAT 2032 01:13:55,920 --> 01:13:57,080 WOULD BE SOMETHING THAT COULD 2033 01:13:57,080 --> 01:14:01,320 REALLY HELP THE SITUATION. 2034 01:14:01,320 --> 01:14:03,400 >> JUSTIN, DID YOU WANT TO SAY 2035 01:14:03,400 --> 01:14:03,680 SOMETHING? 2036 01:14:03,680 --> 01:14:07,240 >> I JUST WONDER, IS THERE AN 2037 01:14:07,240 --> 01:14:08,720 AVENUE HERE WHERE -- COULD WE 2038 01:14:08,720 --> 01:14:10,280 PARTNER WITH COMPANIES LIKE HE 2039 01:14:10,280 --> 01:14:18,880 PICE.EPIC, HOSPITALS COULD CHOOSE TO 2040 01:14:18,880 --> 01:14:20,360 ADOPT OR NOT ADOPT THEM BUT 2041 01:14:20,360 --> 01:14:21,520 THERE'S SOME FRAMEWORK THAT'S 2042 01:14:21,520 --> 01:14:22,800 JUST EASY TO GIVE TO ANY 2043 01:14:22,800 --> 01:14:24,240 HOSPITAL THAT HAS THAT EMR 2044 01:14:24,240 --> 01:14:25,560 SYSTEM AND WORK WITH THE BIG 2045 01:14:25,560 --> 01:14:26,760 COMPANIES, YOU KNOW, THAT HAVE 2046 01:14:26,760 --> 01:14:28,080 THAT, SO AT LEAST THERE'S A 2047 01:14:28,080 --> 01:14:29,160 LAUNCHING PLATFORM THAT EVERY 2048 01:14:29,160 --> 01:14:30,560 HOSPITAL CAN USE TO THEN MAKE 2049 01:14:30,560 --> 01:14:34,840 THESE EDITS. 2050 01:14:34,840 --> 01:14:36,040 >> I THINK THAT'S A GREAT 2051 01:14:36,040 --> 01:14:36,360 SUGGESTION. 2052 01:14:36,360 --> 01:14:38,360 I DON'T KNOW HOW MANY OF YOU ARE 2053 01:14:38,360 --> 01:14:38,680 ON EPIC. 2054 01:14:38,680 --> 01:14:41,840 WE ARE HERE IN CONNECTICUT. 2055 01:14:41,840 --> 01:14:43,280 AND UNBEKNOWNST TO ME BUT AS I 2056 01:14:43,280 --> 01:14:44,680 STARTED WORKING MORE AND MORE 2057 01:14:44,680 --> 01:14:47,120 WITH EPIC, EPIC HAS A LOT OF 2058 01:14:47,120 --> 01:14:48,280 MODULES ALREADY BUILT INTO IT, 2059 01:14:48,280 --> 01:14:50,240 THAT THEY DON'T PUBLICIZE. 2060 01:14:50,240 --> 01:14:52,200 LIKE THEY HAVE A MODULE TO DEAL 2061 01:14:52,200 --> 01:14:54,080 WITH DEPRESSION CALLED SAD, AND 2062 01:14:54,080 --> 01:14:56,920 THEY HAVE A MODULE TO DEAL WITH 2063 01:14:56,920 --> 01:14:58,000 CHILDBIRTH CALLED STORK. 2064 01:14:58,000 --> 01:14:59,400 FOR SOME REASON, THEY DON'T LET 2065 01:14:59,400 --> 01:15:00,280 EVERYBODY KNOW ABOUT THIS, BUT 2066 01:15:00,280 --> 01:15:02,360 IT'S A WELL-KEPT SECRET. 2067 01:15:02,360 --> 01:15:05,200 SO IF YOU'RE ON EPIC OR ANOTHER 2068 01:15:05,200 --> 01:15:06,400 EMR, I THINK THE STARTING PLACE 2069 01:15:06,400 --> 01:15:08,040 IS TO ASK THEM, HEY, WHAT 2070 01:15:08,040 --> 01:15:10,200 MODULES ARE ALREADY BUILT IN TO 2071 01:15:10,200 --> 01:15:12,080 YOUR EMR SO YOU DON'T HAVE TO 2072 01:15:12,080 --> 01:15:15,040 REINVENT THE WHEEL? 2073 01:15:15,040 --> 01:15:18,360 SO I FOUND THAT EYE OPENING 2074 01:15:18,360 --> 01:15:20,360 BECAUSE THE EPIC PEOPLE AT LEAST 2075 01:15:20,360 --> 01:15:21,800 ARE NOT AS FORTHCOMING WITH THIS 2076 01:15:21,800 --> 01:15:28,360 AS YOU WOULD HOPE THEY WOULD BE. 2077 01:15:28,360 --> 01:15:29,640 >> MARK, JUST ONE QUICK COMMENT 2078 01:15:29,640 --> 01:15:32,960 RELATING TO SOMETHING THAT LARRY 2079 01:15:32,960 --> 01:15:33,800 SAID. 2080 01:15:33,800 --> 01:15:36,040 IN THE V.A. TELESTROKENET WORK, 2081 01:15:36,040 --> 01:15:38,040 WE HAVE REALLY FOCUSED ON ACUTE 2082 01:15:38,040 --> 01:15:38,240 CARE. 2083 01:15:38,240 --> 01:15:40,960 WE ARE NOW EXPLORING, STARTING 2084 01:15:40,960 --> 01:15:42,880 WITH A FEW RURAL HOSPITALS THAT 2085 01:15:42,880 --> 01:15:45,600 HAVE NO NEUROLOGISTS ON THEIR 2086 01:15:45,600 --> 01:15:46,800 STAFF, AT LEAST NOT FOR 2087 01:15:46,800 --> 01:15:50,160 INPATIENT CARE, TO DO SORT OF A 2088 01:15:50,160 --> 01:15:54,000 RAPID TIA CLINIC AND THEN EARLY 2089 01:15:54,000 --> 01:15:55,560 FOLLOW-UP BEFORE DISCHARGE FOR 2090 01:15:55,560 --> 01:15:57,320 SECONDARY PREVENTION. 2091 01:15:57,320 --> 01:16:00,120 THAT'S NEW. 2092 01:16:00,120 --> 01:16:01,360 THERE WERE ADVANTAGES AND 2093 01:16:01,360 --> 01:16:03,640 DISADVANTAGES TO THE NETWORK, 2094 01:16:03,640 --> 01:16:05,640 BUT IT DOES HELP TO BALANCE OUT 2095 01:16:05,640 --> 01:16:06,720 PEAK CAPACITY WHEN THINGS ARE 2096 01:16:06,720 --> 01:16:08,320 LESS BUSY BY HAVING PROVIDERS DO 2097 01:16:08,320 --> 01:16:09,960 THINGS THAT HAVE MORE 2098 01:16:09,960 --> 01:16:11,040 FLEXIBILITY IN SCHEDULING. 2099 01:16:11,040 --> 01:16:14,000 IT DOES REQUIRE A VERY DIFFERENT 2100 01:16:14,000 --> 01:16:15,640 WORKFLOW THAN HYPERACUTE CARE, 2101 01:16:15,640 --> 01:16:17,680 AND SO IT HAS BEEN A BIT MORE 2102 01:16:17,680 --> 01:16:18,760 CHALLENGING, AT LEAST IN THIS 2103 01:16:18,760 --> 01:16:20,320 SYSTEM, TO IMPLEMENT, BUT I 2104 01:16:20,320 --> 01:16:21,760 THINK YOU'RE CORRECT IN THAT IT 2105 01:16:21,760 --> 01:16:23,960 IS NOT QUITE ENOUGH FOR MANY OF 2106 01:16:23,960 --> 01:16:25,120 OUR RURAL HOSPITALS, 2107 01:16:25,120 --> 01:16:28,360 PARTICULARLY THOSE THAT ARE 2108 01:16:28,360 --> 01:16:30,480 ISOLATED FROM ANY INPATIENT 2109 01:16:30,480 --> 01:16:32,120 NEUROLOGIC EXPERTISE, TO JUST 2110 01:16:32,120 --> 01:16:34,400 FOCUS ONLY ON THE ACUTE CARE, 2111 01:16:34,400 --> 01:16:36,480 EVEN IF THEY TRANSFER OUT ALL 2112 01:16:36,480 --> 01:16:38,360 STROKES, THERE'S THE TIAs, 2113 01:16:38,360 --> 01:16:39,640 THERE'S THE PATIENT THAT COMES 2114 01:16:39,640 --> 01:16:42,120 BACK FOR SOMETHING ELSE BUT 2115 01:16:42,120 --> 01:16:43,560 THEIR SECONDARY PREVENTION HAS 2116 01:16:43,560 --> 01:16:44,600 BEEN -- YOU KNOW, THE BALL HAS 2117 01:16:44,600 --> 01:16:45,960 BEEN DROPPED, AND THINK THIS IS 2118 01:16:45,960 --> 01:16:47,760 A VERY IMPORTANT ASPECT FOR 2119 01:16:47,760 --> 01:16:49,920 SMALLER HOSPITALS AND RURAL 2120 01:16:49,920 --> 01:16:50,920 CARE, WHERE PEOPLE DON'T HAVE 2121 01:16:50,920 --> 01:16:53,960 ACCESS TO VASCULAR NEUROLOGY BUT 2122 01:16:53,960 --> 01:16:55,280 THEY DON'T HAVE ACCESSORILY TO 2123 01:16:55,280 --> 01:16:56,440 ANY NEUROLOGY IN SOME CASE. 2124 01:16:56,440 --> 01:16:58,000 >> AND I THINK, GLEN, TO EXPAND 2125 01:16:58,000 --> 01:17:01,720 ON WHAT YOU'RE SAYING, IT CAN 2126 01:17:01,720 --> 01:17:05,360 CHANGE THE DYNAMIC OF THE 2127 01:17:05,360 --> 01:17:05,960 TRANSFER SITUATION, BECAUSE 2128 01:17:05,960 --> 01:17:07,960 HOPEFULLY FEWER PATIENTS NEED TO 2129 01:17:07,960 --> 01:17:09,800 BE TRANSFERRED IF THERE'S NO 2130 01:17:09,800 --> 01:17:11,120 NEUROLOGY EXPERTISE, IF THERE'S 2131 01:17:11,120 --> 01:17:13,160 NO STROKE EXPERTISE, THEN 2132 01:17:13,160 --> 01:17:15,480 THEY'RE MORE LIKELY TO TRANSFER 2133 01:17:15,480 --> 01:17:17,400 THAT PATIENT, BUT IF YOU'RE 2134 01:17:17,400 --> 01:17:18,960 DELIVERING THAT EXPERTISE BY 2135 01:17:18,960 --> 01:17:19,960 TELEMEDICINE, MAYBE THEY FEEL 2136 01:17:19,960 --> 01:17:21,000 MORE COMFORTABLE KEEPING THE 2137 01:17:21,000 --> 01:17:24,600 PATIENT AT THE HOSPITAL, AND 2138 01:17:24,600 --> 01:17:33,840 TIAs AND MINOR STROKES AND LA 2139 01:17:33,840 --> 01:17:35,760 KUHNS FOR WHICH THOSE PATIENTS 2140 01:17:35,760 --> 01:17:36,760 ARE TRANSFERRED THAT WE DON'T DO 2141 01:17:36,760 --> 01:17:38,200 A WHOLE LOT OF AT THE COMMUNITY 2142 01:17:38,200 --> 01:17:40,480 HOSPITAL ANYWAY, AND MAYBE THOSE 2143 01:17:40,480 --> 01:17:41,720 PATIENTS COULD STAY AT THE 2144 01:17:41,720 --> 01:17:42,440 COMMUNITY HOSPITAL AND THE 2145 01:17:42,440 --> 01:17:44,880 STROKE CENTERS WHICH ARE 2146 01:17:44,880 --> 01:17:45,960 BASICALLY -- WE'RE ALL 2147 01:17:45,960 --> 01:17:47,360 OVERWHELMED WITH STROKE 2148 01:17:47,360 --> 01:17:48,560 PATIENTS -- DON'T HAVE TO GET 2149 01:17:48,560 --> 01:17:49,680 ALL THESE PATIENTS THAT WE'RE 2150 01:17:49,680 --> 01:17:51,840 NOT GOING TO DO ANYTHING 2151 01:17:51,840 --> 01:17:52,720 TERRIBLY DIFFERENT FOR, AS LONG 2152 01:17:52,720 --> 01:17:54,640 AS THEY CAN STILL HAVE THE 2153 01:17:54,640 --> 01:17:56,160 STROKE EXPERTISE FOR MAKING SURE 2154 01:17:56,160 --> 01:17:57,880 THEY GET THE PROPER WORKUP AND 2155 01:17:57,880 --> 01:17:59,400 THE DECISIONS ARE MADE FOR 2156 01:17:59,400 --> 01:18:01,480 SECONDARY STROKE PREVENTION UPON 2157 01:18:01,480 --> 01:18:03,880 DISCHARGE BY SOMEONE WITH STROKE 2158 01:18:03,880 --> 01:18:04,880 EXPERTISE BY TELEMEDICINE. 2159 01:18:04,880 --> 01:18:07,360 AND THEN THERE'S ALSO THE 2160 01:18:07,360 --> 01:18:09,000 HEMORRHAGES WITH VERY SMALL 2161 01:18:09,000 --> 01:18:11,440 HEMORRHAGES AND VERY LARGE 2162 01:18:11,440 --> 01:18:12,760 HEMORRHAGES, WHICH PERHAPS IF 2163 01:18:12,760 --> 01:18:14,920 THERE'S STROKE SUPPORT BY 2164 01:18:14,920 --> 01:18:16,160 TELEMEDICINE, MAYBE THOSE 2165 01:18:16,160 --> 01:18:17,880 PATIENTS DON'T REALLY NEED TO BE 2166 01:18:17,880 --> 01:18:18,360 TRANSFERRED AS WELL. 2167 01:18:18,360 --> 01:18:22,320 SO I THINK THERE ARE SOME BIG 2168 01:18:22,320 --> 01:18:22,600 ADVANTAGES. 2169 01:18:22,600 --> 01:18:25,480 THE DISADVANTAGE IS THAT IT IS 2170 01:18:25,480 --> 01:18:27,520 TIME-INTENSIVE, AND AGAIN, IT'S 2171 01:18:27,520 --> 01:18:28,040 RESOURCE-INTENSIVE FOR THE 2172 01:18:28,040 --> 01:18:28,640 PROVIDERS. 2173 01:18:28,640 --> 01:18:30,640 IT'S JUST ANOTHER ADDED BURDEN 2174 01:18:30,640 --> 01:18:32,680 FOR THE STROKE DOCTORS IN 2175 01:18:32,680 --> 01:18:34,320 ADDITION TO EVERYTHING THAT 2176 01:18:34,320 --> 01:18:38,120 THEY'RE ALREADY DOING TO BE 2177 01:18:38,120 --> 01:18:39,240 SEEING THESE PATIENTS AT 2178 01:18:39,240 --> 01:18:40,360 MULTIPLE COMMUNITY HOSPITALS 2179 01:18:40,360 --> 01:18:44,560 ONCE OR TWICE OR WHATEVER THAT 2180 01:18:44,560 --> 01:18:47,240 BURDEN IS, AND SO THOSE THINGS 2181 01:18:47,240 --> 01:18:49,520 HAVE TO BE BALANCED, BUT I THINK 2182 01:18:49,520 --> 01:18:51,040 THE POSSIBILITIES ARE THERE. 2183 01:18:51,040 --> 01:18:51,560 >> SURE. 2184 01:18:51,560 --> 01:18:53,680 JUST A FEW COMMENTS ON THAT FROM 2185 01:18:53,680 --> 01:18:54,640 OUR EXPERIENCE. 2186 01:18:54,640 --> 01:18:56,360 FIRSTLY, YOU'RE ABSOLUTELY RIGHT 2187 01:18:56,360 --> 01:18:59,120 IN THAT IN THE ABSENCE OF THE 2188 01:18:59,120 --> 01:19:01,760 ABILITY TO GET A NEUROLOGY 2189 01:19:01,760 --> 01:19:03,720 CONSULT OR SHORT TERM NEUROLOGY 2190 01:19:03,720 --> 01:19:04,920 FOLLOW-UP, THERE'S A TENDENCY OF 2191 01:19:04,920 --> 01:19:06,720 COMMUNITY HOSPITALS TO WANT TO 2192 01:19:06,720 --> 01:19:08,720 SEND -- YOU KNOW, OUT OF 2193 01:19:08,720 --> 01:19:10,800 MEDICAL-LEGAL OR OTHER FEAR, TO 2194 01:19:10,800 --> 01:19:11,360 SEND EVERYTHING OUT. 2195 01:19:11,360 --> 01:19:13,440 THIS CAN REPRESENT MILLIONS OF 2196 01:19:13,440 --> 01:19:14,880 DOLLARS OF COST PER YEAR FOR A 2197 01:19:14,880 --> 01:19:16,720 LARGER BUT STILL COMMUNITY 2198 01:19:16,720 --> 01:19:18,560 HOSPITAL, NON-COMPREHENSIVE 2199 01:19:18,560 --> 01:19:20,360 STROKE CENTER. 2200 01:19:20,360 --> 01:19:24,800 WE HAVE STUDIED THIS BOTH 2201 01:19:24,800 --> 01:19:26,560 ANECDOTALLY, A FEW OF OUR V.A.S, 2202 01:19:26,560 --> 01:19:29,720 WE HAVE A PAPER IN PRESS OF JUST 2203 01:19:29,720 --> 01:19:31,480 THIS POINT, THAT IT CLEARLY 2204 01:19:31,480 --> 01:19:36,720 REDUCES TRANSFER EVEN THOUGH WE 2205 01:19:36,720 --> 01:19:37,920 DON'T -- I THINK YOUR POINT IS 2206 01:19:37,920 --> 01:19:43,360 WELL TAKEN. 2207 01:19:43,360 --> 01:19:44,920 >> LARRY, THE OTHER ASPECT OF 2208 01:19:44,920 --> 01:19:46,560 THIS I LEARNED WORKING WITH THE 2209 01:19:46,560 --> 01:19:51,320 JOINT COMMISSION IS OBVIOUSLY 2210 01:19:51,320 --> 01:19:54,200 THINGS LIKE TPA AND EVT, IT'S A 2211 01:19:54,200 --> 01:19:56,720 TIME-SENSITIVE TRIAGE DECISION. 2212 01:19:56,720 --> 01:19:58,120 BUT WHAT THEY TAUGHT ME FROM 2213 01:19:58,120 --> 01:19:59,480 THEIR EXPERIENCE GOING TO MANY 2214 01:19:59,480 --> 01:20:01,080 THOUSANDS OF HOSPITALS IS THAT 2215 01:20:01,080 --> 01:20:03,440 IF A HOSPITAL IS DEFICIENT IN 2216 01:20:03,440 --> 01:20:05,440 ONE ELEMENT OF CARE, ODDS ARE 2217 01:20:05,440 --> 01:20:08,080 THAT THEY ARE DEFICIENT IN OTHER 2218 01:20:08,080 --> 01:20:09,720 ELEMENTS OF CARE EITHER. 2219 01:20:09,720 --> 01:20:11,560 IT SORT OF LIKE A RED FLAG FOR 2220 01:20:11,560 --> 01:20:14,640 THEM, THAT IF THEY DON'T HAVE 2221 01:20:14,640 --> 01:20:16,360 EXPERTISE HERE, THEY MAY NOT 2222 01:20:16,360 --> 01:20:17,800 HAVE EXPERTISE THERE. 2223 01:20:17,800 --> 01:20:19,600 SO SOME PATIENTS DO NEED TO BE 2224 01:20:19,600 --> 01:20:21,120 TRANSFERRED AND SOME PATIENTS 2225 01:20:21,120 --> 01:20:21,880 DON'T. 2226 01:20:21,880 --> 01:20:26,640 WHENEVER I'VE DONE 2227 01:20:26,640 --> 01:20:27,320 TELESTROKE-TYPE THINGS ABOVE AND 2228 01:20:27,320 --> 01:20:31,960 BEYOND THE HYPERACUTE TRE TRIAGE 2229 01:20:31,960 --> 01:20:32,840 DECISION, I'M ALWAYS A LITTLE 2230 01:20:32,840 --> 01:20:35,360 BIT CONCERNED THAT AM I ENABLING 2231 01:20:35,360 --> 01:20:37,360 A PATIENT TO BE IN A CARE 2232 01:20:37,360 --> 01:20:43,720 SETTING THAT ALMOST, BY 2233 01:20:43,720 --> 01:20:44,360 DEFINITION, HAS EVERYTHING THEY 2234 01:20:44,360 --> 01:20:44,760 NEED. 2235 01:20:44,760 --> 01:20:46,280 DOES THAT APPLY TO EVERY PATIENT 2236 01:20:46,280 --> 01:20:47,000 IN EVERY SETTING? 2237 01:20:47,000 --> 01:20:47,720 OF COURSE NOT. 2238 01:20:47,720 --> 01:20:49,240 BUT THE FACT THAT WE'RE 2239 01:20:49,240 --> 01:20:49,960 PROVIDING TELESTROKE SERVICES 2240 01:20:49,960 --> 01:20:51,520 ABOVE AND BEYOND THE HYPERACUTE 2241 01:20:51,520 --> 01:20:53,160 SETTING, IT JUST ALWAYS MADE ME 2242 01:20:53,160 --> 01:20:56,360 A LITTLE BIT UNEASY THAT I WAS 2243 01:20:56,360 --> 01:20:58,320 SORT OF ENABLING HOSPITAL TO 2244 01:20:58,320 --> 01:21:01,240 MAYBE NOT GET UP TO THE LEVEL OF 2245 01:21:01,240 --> 01:21:02,360 CARE THAT THEY SHOULD BE GETTING 2246 01:21:02,360 --> 01:21:03,960 UP TO, AND IT GOES BACK TO A 2247 01:21:03,960 --> 01:21:07,920 THING WE SPOKE ABOUT YESTERDAY, 2248 01:21:07,920 --> 01:21:12,600 AND THE BAC HAS DONE THIS, THE 2249 01:21:12,600 --> 01:21:14,120 AHA AND OA SET EGG STANDARDS OF 2250 01:21:14,120 --> 01:21:14,360 CARE. 2251 01:21:14,360 --> 01:21:18,320 THIS IS THE STANDARD OF CARE FOR 2252 01:21:18,320 --> 01:21:18,920 TPA, CARDIOEMBOLIC STROKE OR 2253 01:21:18,920 --> 01:21:19,560 WHATEVER IT MAY BE. 2254 01:21:19,560 --> 01:21:20,880 IT'S UP TO US IN THE HOSPITALS 2255 01:21:20,880 --> 01:21:21,760 TO FIGURE OUT HOW THEY'RE GOING 2256 01:21:21,760 --> 01:21:23,360 TO MEET THAT STANDARD OF CARE, 2257 01:21:23,360 --> 01:21:26,200 NOT TO LOWER THE STANDARD OF 2258 01:21:26,200 --> 01:21:28,040 CARE BECAUSE THEY'RE AT LOCATION 2259 01:21:28,040 --> 01:21:29,400 A, B OR C. 2260 01:21:29,400 --> 01:21:35,520 I THINK THAT' THAT SORT OF IS A SELF 2261 01:21:35,520 --> 01:21:36,520 PERPETUATING CYCLE WHERE THEY'RE 2262 01:21:36,520 --> 01:21:37,920 NOT DOING ALL THAT THEY COULD OR 2263 01:21:37,920 --> 01:21:38,320 SHOULD DO. 2264 01:21:38,320 --> 01:21:40,560 >> SO I GET YOUR POINT, MARK. 2265 01:21:40,560 --> 01:21:42,200 THAT'S A GOOD POINT. 2266 01:21:42,200 --> 01:21:46,560 BUT I WOULD JUST COMMENT FURTHER 2267 01:21:46,560 --> 01:21:49,280 THAT THERE'S NO PERFECT SOLUTION 2268 01:21:49,280 --> 01:21:50,600 OBVIOUSLY, BUT I THINK THE 2269 01:21:50,600 --> 01:21:52,200 QUESTION IS, CAN WE BRING THE 2270 01:21:52,200 --> 01:21:54,760 STANDARD OF CARE AT A COMMUNITY 2271 01:21:54,760 --> 01:21:56,280 HOSPITAL UP TO WHERE WE WANT IT, 2272 01:21:56,280 --> 01:21:58,880 AND WHAT IT SHOULD BE, OR WHAT 2273 01:21:58,880 --> 01:22:02,160 IT IS AT A STROKE CENTER BY 2274 01:22:02,160 --> 01:22:03,720 SUPPORTING THEM IN THESE WAYS? 2275 01:22:03,720 --> 01:22:07,760 NOT JUST TELEMEDICINE, BUT THE 2276 01:22:07,760 --> 01:22:09,160 ORDER SETS, THE PATHWAYS, ALL OF 2277 01:22:09,160 --> 01:22:10,280 THAT TOGETHER, CAN WE BRING IT 2278 01:22:10,280 --> 01:22:12,120 UP TO A GOOD STANDARD. 2279 01:22:12,120 --> 01:22:18,080 BECAUSE IT'S JUST IMPRACTICAL 2280 01:22:18,080 --> 01:22:19,880 FOR ALL OF THESE STROKE PATIENTS 2281 01:22:19,880 --> 01:22:21,480 TO BE SENT TO OUR HOSPITALS. 2282 01:22:21,480 --> 01:22:22,760 WE'RE OVERWHELMED, THE STROKE 2283 01:22:22,760 --> 01:22:24,560 DOCTORS ARE OVERWHELMED, 2284 01:22:24,560 --> 01:22:25,400 EVERYBODY'S BURNED OUT. 2285 01:22:25,400 --> 01:22:27,720 THE CALL IS JUST GETTING 2286 01:22:27,720 --> 01:22:28,760 RIDICULOUS. 2287 01:22:28,760 --> 01:22:30,960 AND TO THE EXTENT THAT WE 2288 01:22:30,960 --> 01:22:32,360 HAVE -- YOU KNOW, THERE ARE 2289 01:22:32,360 --> 01:22:33,280 CERTAINLY PATIENTS WHO NEED TO 2290 01:22:33,280 --> 01:22:35,560 COME IN TO OUR HOSPITALS. 2291 01:22:35,560 --> 01:22:39,280 THE PATIENTS WHO GET 2292 01:22:39,280 --> 01:22:40,360 ENDOVASCULAR THERAPY, THE 2293 01:22:40,360 --> 01:22:42,000 PATIENTS WHO MAY HAVE A LEM RAJ 2294 01:22:42,000 --> 01:22:46,480 THAT COULHEMORRHAGE WHO NEED SURGERY, 2295 01:22:46,480 --> 01:22:52,080 PATIENTS WHO NEED DECOMPRESSIVE 2296 01:22:52,080 --> 01:22:52,600 HEMIECTOMIES. 2297 01:22:52,600 --> 01:22:53,720 BUT THERE ARE SOME THAT DON'T 2298 01:22:53,720 --> 01:22:55,000 NEED TO COME DOWN TO US THAT 2299 01:22:55,000 --> 01:22:56,320 COULD BE CARED FOR STILL IN THE 2300 01:22:56,320 --> 01:22:57,720 COMMUNITY, AND I THINK THAT 2301 01:22:57,720 --> 01:23:00,120 WOULD HELP THIS PROBLEM OF THE 2302 01:23:00,120 --> 01:23:01,400 OVERWHELMED STROKE CENTERS, 2303 01:23:01,400 --> 01:23:02,440 NUMBER ONE, BUT IT'S ALSO BETTER 2304 01:23:02,440 --> 01:23:03,960 FOR THE PATIENTS IF THEY GET 2305 01:23:03,960 --> 01:23:05,720 GOOD CARE TO STAY IN THEIR 2306 01:23:05,720 --> 01:23:07,040 COMMUNITY WHERE THEIR FAMILIES 2307 01:23:07,040 --> 01:23:08,760 ARE, WHERE THEY FEEL 2308 01:23:08,760 --> 01:23:10,960 COMFORTABLE, AND SO ON. 2309 01:23:10,960 --> 01:23:12,920 SO HOPEFULLY IT COULD BE A 2310 01:23:12,920 --> 01:23:16,160 WIN-WIN FOR EVERYBODY. 2311 01:23:16,160 --> 01:23:18,680 >> SURE, I AGREE, LARRY, 2312 01:23:18,680 --> 01:23:19,760 ABSOLUTELY, JUST TO MAKE A 2313 01:23:19,760 --> 01:23:20,560 COUPLE MORE POINTS. 2314 01:23:20,560 --> 01:23:26,880 ANOTHER THING WE CAN DO FOR 2315 01:23:26,880 --> 01:23:28,080 SITES IS ONGOING EDUCATION. 2316 01:23:28,080 --> 01:23:29,600 AND I THINK THAT'S VITAL TO 2317 01:23:29,600 --> 01:23:31,840 RAISE THE LEVEL OF CARE IN A 2318 01:23:31,840 --> 01:23:34,400 HOSPITAL THAT HAS LIMITED 2319 01:23:34,400 --> 01:23:36,480 EXPERIENCE WITH STROKE PRIOR. 2320 01:23:36,480 --> 01:23:37,560 BUT YOU ALSO RAISE THE QUESTION, 2321 01:23:37,560 --> 01:23:40,080 WHICH IS PARTICULARLY ACUTE IN 2322 01:23:40,080 --> 01:23:41,440 RURAL AREAS, SOMETIME IN A 2323 01:23:41,440 --> 01:23:42,960 REGION THERE MAY BE JUST ONE 2324 01:23:42,960 --> 01:23:43,480 STROKE CENTER. 2325 01:23:43,480 --> 01:23:45,960 IT MAY NOT EVEN BE A FULL 2326 01:23:45,960 --> 01:23:47,320 COMPREHENSIVE STROKE CENTER. 2327 01:23:47,320 --> 01:23:49,560 HOSPITALS ARE OFTEN VERY 2328 01:23:49,560 --> 01:23:52,440 COMFORTABLE WITH THE ISSUE THAT 2329 01:23:52,440 --> 01:23:56,600 WE SEND EVERY SINGLE STROKE, 2330 01:23:56,600 --> 01:23:57,440 POSSIBLE STROKE, MIGHT BE A 2331 01:23:57,440 --> 01:23:58,080 STROKE, OUT. 2332 01:23:58,080 --> 01:24:00,680 THIS CAN ABSOLUTELY OVERWHELM A 2333 01:24:00,680 --> 01:24:01,080 REGIONAL SYSTEM. 2334 01:24:01,080 --> 01:24:03,040 WUNL OF THE FIRST PATIENTS WE 2335 01:24:03,040 --> 01:24:04,360 TREATED WAS BECAUSE THE REGIONAL 2336 01:24:04,360 --> 01:24:05,440 STROKE CENTER REFUSED TO 2337 01:24:05,440 --> 01:24:06,640 TRANSFER BECAUSE THEY WERE 2338 01:24:06,640 --> 01:24:08,160 ABSOLUTELY ABOVE CAPACITY. 2339 01:24:08,160 --> 01:24:11,840 AND WE'VE HAD THIS OCCASION. 2340 01:24:11,840 --> 01:24:13,960 SO I THINK THE DEFAULT OF WE 2341 01:24:13,960 --> 01:24:15,040 DON'T TREAT STROKE HERE, WE'RE 2342 01:24:15,040 --> 01:24:16,440 GOING TO SEND ABSOLUTELY 2343 01:24:16,440 --> 01:24:18,760 EVERYBODY OUT, REALLY CAUSES AN 2344 01:24:18,760 --> 01:24:21,680 UNDUE PRESSURE AND HAS LIKELY 2345 01:24:21,680 --> 01:24:23,400 MORE NEGATIVE CONSEQUENCES FOR A 2346 01:24:23,400 --> 01:24:25,480 PATIENT POPULATION THAN A 2347 01:24:25,480 --> 01:24:33,200 NUANCED APPROACH. 2348 01:24:33,200 --> 01:24:35,000 >> I ALSO THINK IT'S FAIR THAT 2349 01:24:35,000 --> 01:24:35,800 WE DON'T PAINT ALL OF THESE 2350 01:24:35,800 --> 01:24:37,000 CENTERS WITH THE SAME BRUSH. 2351 01:24:37,000 --> 01:24:38,160 SOME OF THEM HAVE DIFFERENT 2352 01:24:38,160 --> 01:24:39,640 SUPPORT NETWORKS AND SUPPORT 2353 01:24:39,640 --> 01:24:41,240 SYSTEMS, AND IT'S PROBABLY 2354 01:24:41,240 --> 01:24:43,760 UNFAIR AND UNWISE TO PAY THEM, 2355 01:24:43,760 --> 01:24:44,920 JUST LIKE PRIMARY CARE 2356 01:24:44,920 --> 01:24:45,880 PHYSICIANS THAT YOU AND I DEAL 2357 01:24:45,880 --> 01:24:46,640 WITH ALL THE TIME. 2358 01:24:46,640 --> 01:24:49,360 SOME OF THEM PRACTICE AT A VERY 2359 01:24:49,360 --> 01:24:50,560 HIGH LEVEL, SOME OF THEM ARE 2360 01:24:50,560 --> 01:24:52,280 SORT OF MEDIOCRE, AND SOME OF 2361 01:24:52,280 --> 01:24:53,840 THEM DON'T DO A GOOD JOB WITH 2362 01:24:53,840 --> 01:24:55,520 SECONDARY STROKE PREVENTION. 2363 01:24:55,520 --> 01:24:57,360 THERE'S VERY LACKADAISICAL. 2364 01:24:57,360 --> 01:24:58,880 SO I AGREE, IT'S UNFAIR TO PAINT 2365 01:24:58,880 --> 01:25:03,040 THEM ALL WITH ONE BRUSH. 2366 01:25:03,040 --> 01:25:04,360 OTHER COMMENTS OR QUESTIONS? 2367 01:25:04,360 --> 01:25:06,360 WE HAVE ABOUT 45 OR 50 PEOPLE ON 2368 01:25:06,360 --> 01:25:11,720 THE CALL. 2369 01:25:11,720 --> 01:25:12,760 THIS IS YOUR CLANS TO PROVIDE 2370 01:25:12,760 --> 01:25:15,480 INPUT. 2371 01:25:15,480 --> 01:25:16,200 CHANCE TO PROVIDE 2372 01:25:16,200 --> 01:25:20,240 INPUT. 2373 01:25:20,240 --> 01:25:21,880 RICHARD, ANY PERSPECTIVES FROM 2374 01:25:21,880 --> 01:25:23,320 YOUR POINT OF VIEW? 2375 01:25:23,320 --> 01:25:25,280 HAVE WE DONE A SUFFICIENT JOB 2376 01:25:25,280 --> 01:25:29,560 TOUCHING ON DISPARITIES AND LACK 2377 01:25:29,560 --> 01:25:31,040 OF EQUITY AMONG DIFFERENT 2378 01:25:31,040 --> 01:25:34,240 POPULATIONS, DIFFERENT GROUPS? 2379 01:25:34,240 --> 01:25:36,320 >> I THINK THIS HAS BEEN A 2380 01:25:36,320 --> 01:25:38,600 REALLY EXCELLENT DISCUSSION, AND 2381 01:25:38,600 --> 01:25:39,560 DISTILLATION OF EVERYTHING THAT 2382 01:25:39,560 --> 01:25:42,560 WAS PRESENTED ON YESTERDAY. 2383 01:25:42,560 --> 01:25:44,960 I'M JUST HERE TAKING NOTES AND 2384 01:25:44,960 --> 01:25:46,160 SENDING INFORMATION BACK AND 2385 01:25:46,160 --> 01:25:47,880 FORTH ABOUT SOME OF THE 2386 01:25:47,880 --> 01:25:48,640 WONDERFUL DISCUSSIONS THAT WE'VE 2387 01:25:48,640 --> 01:25:50,520 HAD. 2388 01:25:50,520 --> 01:25:56,280 AND I THINK THIS IS GREAT. 2389 01:25:56,280 --> 01:25:59,720 SO I'M OPENING TO OTHER PEOPLE 2390 01:25:59,720 --> 01:26:13,920 TO OFFER THEIR COMMENTS. 2391 01:26:13,920 --> 01:26:15,760 >> GOING ONCE, GOING TWICE? 2392 01:26:15,760 --> 01:26:19,760 WE'VE ASSEMBLED A FEW SUMMARY 2393 01:26:19,760 --> 01:26:22,280 SLIDES THAT IF RICHARD AND SAM 2394 01:26:22,280 --> 01:26:23,800 AGREE, PROBABLY BETTER JUST TO 2395 01:26:23,800 --> 01:26:26,400 EMAIL TO YOU INSTEAD OF GOING 2396 01:26:26,400 --> 01:26:27,480 THROUGH THEM ONE BY ONE, BUT WE 2397 01:26:27,480 --> 01:26:28,520 HAVE CAPTURED SOME OF THE 2398 01:26:28,520 --> 01:26:30,240 SUMMARY POINTS OF THIS MORNING'S 2399 01:26:30,240 --> 01:26:31,240 DISCUSSIONS. 2400 01:26:31,240 --> 01:26:33,160 TRYING TO DO THESE SLIDES ON THE 2401 01:26:33,160 --> 01:26:35,560 FLY IS ALWAYS CHALLENGING, AND 2402 01:26:35,560 --> 01:26:37,760 YOU KNOW, WE CAN GO OVER THEM 2403 01:26:37,760 --> 01:26:39,960 AND SEND THEM OUT TO YOU EARLY 2404 01:26:39,960 --> 01:26:41,480 NEXT WEEK. 2405 01:26:41,480 --> 01:26:43,920 JUST A SUMMATION IF THAT'S 2406 01:26:43,920 --> 01:26:45,880 AGREEABLE TO RICHARD AND SAM. 2407 01:26:45,880 --> 01:26:50,640 ARE YOU OKAY WITH THAT? 2408 01:26:50,640 --> 01:26:52,120 >> MARK, WE CAN UPDATE THE 2409 01:26:52,120 --> 01:26:53,080 MEETING WEBSITE AND PUT THE 2410 01:26:53,080 --> 01:26:54,080 INFORMATION THAT'S ON THE SLIDES 2411 01:26:54,080 --> 01:26:55,720 ON THE MEETING WEBSITE, BUT 2412 01:26:55,720 --> 01:26:57,440 WE'RE UNLIKELY TO ACTUALLY 2413 01:26:57,440 --> 01:26:59,160 DISTRIBUTE THE POWERPOINT 2414 01:26:59,160 --> 01:27:00,160 DEMONSTRATION ITSELF, BUT IT 2415 01:27:00,160 --> 01:27:01,480 WILL STILL BE ACCESSIBLE TO 2416 01:27:01,480 --> 01:27:05,160 EVERYONE AFTER THE FACT. 2417 01:27:05,160 --> 01:27:07,960 >> WONDERFUL. 2418 01:27:07,960 --> 01:27:09,480 SO SAM, DO YOU WANT TO GO OVER 2419 01:27:09,480 --> 01:27:12,520 NEXT STEPS IN TERMS OF 2420 01:27:12,520 --> 01:27:13,160 PUBLICATIONS, FOLLOW-ON MEETINGS 2421 01:27:13,160 --> 01:27:17,400 AND THE LIKE? 2422 01:27:17,400 --> 01:27:18,040 >> RIGHT. 2423 01:27:18,040 --> 01:27:21,640 SO SOME OF YOU ARE ALREADY A BIT 2424 01:27:21,640 --> 01:27:23,640 AWARE OF THE ANTICIPATED 2425 01:27:23,640 --> 01:27:25,360 PROCESS, BUT OTHERS, I THINK, 2426 01:27:25,360 --> 01:27:28,800 ARE NOT, SO JUST TO DO A STEP 2427 01:27:28,800 --> 01:27:32,360 BACK OR TWO, YOU KNOW, THE IDEA 2428 01:27:32,360 --> 01:27:35,760 FOR THE SYMPOSIUM AROSE WITH THE 2429 01:27:35,760 --> 01:27:36,960 BRAIN ATTACK COALITION AS THEY 2430 01:27:36,960 --> 01:27:39,040 WERE KIND OF THINKING ABOUT 2431 01:27:39,040 --> 01:27:40,680 REALLY, YOU KNOW, IMPACTFUL 2432 01:27:40,680 --> 01:27:42,120 TOPICS TO CONSIDER. 2433 01:27:42,120 --> 01:27:43,320 AND THIS WAS ACTUALLY A COUPLE 2434 01:27:43,320 --> 01:27:45,760 YEARS A WHEN THE IDEA FIRST 2435 01:27:45,760 --> 01:27:47,680 SURFACED, SO THEN WE ENDED UP 2436 01:27:47,680 --> 01:27:49,200 EVENTUALLY DEVELOPING A STEERING 2437 01:27:49,200 --> 01:27:50,600 COMMITTEE AND THEN THE THREE 2438 01:27:50,600 --> 01:27:52,960 TASK FORCES OF WHICH WE'VE HEARD 2439 01:27:52,960 --> 01:27:54,360 FROM EXTENSIVELY OVER THE PAST 2440 01:27:54,360 --> 01:27:55,440 TWO DAYS. 2441 01:27:55,440 --> 01:28:01,520 AND THOSE GROUPS OF ALL DIVERSE 2442 01:28:01,520 --> 01:28:05,720 SPEAKERS AND EXPERTS, PEOPLE ALL 2443 01:28:05,720 --> 01:28:07,000 ACROSS THE COUNTRY, PEOPLE FROM 2444 01:28:07,000 --> 01:28:08,120 DIFFERENT SECTORS, THEY ARE THE 2445 01:28:08,120 --> 01:28:09,640 ONES WHO DID ALL OF THE HUGE 2446 01:28:09,640 --> 01:28:12,040 LEGWORK TO LEAD TO THE 2447 01:28:12,040 --> 01:28:13,120 PRESENTATIONS THAT YOU SAW 2448 01:28:13,120 --> 01:28:13,920 YESTERDAY, AND OF COURSE THEY 2449 01:28:13,920 --> 01:28:16,120 WERE LED BY ALL OF OUR FANTASTIC 2450 01:28:16,120 --> 01:28:17,800 TASK FORCE LEADS, AND WORKED 2451 01:28:17,800 --> 01:28:19,760 CLOSELY WITH THE STEERING 2452 01:28:19,760 --> 01:28:24,360 COMMITTEE, PARTICULARLY MARK AND 2453 01:28:24,360 --> 01:28:25,560 RICHARD, TO DO THE DRAFT REPORT 2454 01:28:25,560 --> 01:28:27,360 THAT WE HAVE ALL BEEN 2455 01:28:27,360 --> 01:28:27,640 DISCUSSING. 2456 01:28:27,640 --> 01:28:28,720 SO NOW WHAT IS GOING TO HAPPEN 2457 01:28:28,720 --> 01:28:29,760 IS, UNLESS ANYONE HAS ANYTHING 2458 01:28:29,760 --> 01:28:33,200 ELSE THEY WANT TOE TO ADD TODAY, WE 2459 01:28:33,200 --> 01:28:34,520 ARE GOING TO END OUR SYMPOSIUM 2460 01:28:34,520 --> 01:28:35,760 WITH YOU AFTER YOUR INSIGHTS. 2461 01:28:35,760 --> 01:28:37,240 WE HAVE SCIENCE WRITERS WHO HAVE 2462 01:28:37,240 --> 01:28:38,360 BEEN TAKING VERY DETAILED NOTES 2463 01:28:38,360 --> 01:28:41,600 FROM ALL THE DIFFERENT 2464 01:28:41,600 --> 01:28:42,480 DISCUSSIONS, AND ALL OF THIS 2465 01:28:42,480 --> 01:28:43,360 INFORMATION IS GOING TO GO BACK 2466 01:28:43,360 --> 01:28:44,240 TO THE STEERING COMMITTEE AND 2467 01:28:44,240 --> 01:28:46,200 THE TASK FORCES SO THEY ARE ABLE 2468 01:28:46,200 --> 01:28:49,360 TO MAKE SOME TWEAKS, ADDITIONS, 2469 01:28:49,360 --> 01:28:52,960 ET CETERA, TO THE DRAFT REPORT 2470 01:28:52,960 --> 01:28:54,600 WE POSTED ON MEETING WEBSITE IN 2471 01:28:54,600 --> 01:28:55,280 THE COMING MONTHS. 2472 01:28:55,280 --> 01:28:57,200 THE GOAL IS TO HAVE KIND OF A 2473 01:28:57,200 --> 01:28:59,640 REVISED AND FINAL VERSION OF THE 2474 01:28:59,640 --> 01:29:04,000 LONG FORM REPORT BY THIS SUMMER, 2475 01:29:04,000 --> 01:29:06,080 PREFERABLY BY MID, LATE JUNE 2476 01:29:06,080 --> 01:29:09,240 PERHAPS. 2477 01:29:09,240 --> 01:29:10,520 AND AND POTENTIALLY A SHORTER 2478 01:29:10,520 --> 01:29:12,320 FORM KIND OF COMMENTARY THAT HAS 2479 01:29:12,320 --> 01:29:15,040 THE HIGHLIGHTS AT MORE OF AN 2480 01:29:15,040 --> 01:29:16,000 EXECUTIVE SUMMARY FROM ALL OF 2481 01:29:16,000 --> 01:29:17,440 THESE DISCUSSIONS AND FROM THE 2482 01:29:17,440 --> 01:29:19,120 WHOLE REPORT, AND THEN REALLY 2483 01:29:19,120 --> 01:29:22,920 KIND OF POINTS OUT SOME VERY 2484 01:29:22,920 --> 01:29:23,880 TANGIBLE SHORT TERM AND LONG 2485 01:29:23,880 --> 01:29:27,400 TERM ACTION ITEMS FOR THE ENTIRE 2486 01:29:27,400 --> 01:29:28,480 STROKE COMMUNITY TO CONSIDER IN 2487 01:29:28,480 --> 01:29:29,680 THIS SPACE, AND THAT WILL GO 2488 01:29:29,680 --> 01:29:32,400 BACK TO THE BRAIN ATTACK 2489 01:29:32,400 --> 01:29:33,400 COALITION, WHICH IS AGAIN FOR 2490 01:29:33,400 --> 01:29:35,480 THOSE OF WHO YOU DON'T KNOW A 2491 01:29:35,480 --> 01:29:36,040 KIND OF PUBLIC AND PRIVATE 2492 01:29:36,040 --> 01:29:37,000 COALITION INVOLVES AN ASSORTMENT 2493 01:29:37,000 --> 01:29:40,440 OF FEDERAL AGENCIES, NON-PROFIT 2494 01:29:40,440 --> 01:29:41,200 ORGANIZATIONS AND PRIVATE 2495 01:29:41,200 --> 01:29:43,080 ORGANIZATIONS AND HOSPITAL 2496 01:29:43,080 --> 01:29:45,360 SYSTEMS AND THEY WILL REVIEW 2497 01:29:45,360 --> 01:29:46,480 EVERYTHING AND BASICALLY ARE 2498 01:29:46,480 --> 01:29:48,960 GOING TO BE THE COLLECTIVE 2499 01:29:48,960 --> 01:29:52,480 APPROVERS, AND THEN FROM THERE, 2500 01:29:52,480 --> 01:29:53,800 WE AT NINDS WILL BE POSTING THE 2501 01:29:53,800 --> 01:29:55,520 FULL REPORT, THE LONG FORM 2502 01:29:55,520 --> 01:29:57,360 REPORT ON ONE OF OUR WEBSITES, 2503 01:29:57,360 --> 01:29:59,560 SO IT IS NICE AND ACCESSIBLE. 2504 01:29:59,560 --> 01:30:01,960 AND THEN WE WILL LOOK INTO 2505 01:30:01,960 --> 01:30:04,600 PUBLISHING THE SHORTER FORM IN A 2506 01:30:04,600 --> 01:30:06,520 JOURNAL THAT IS STILL TO BE 2507 01:30:06,520 --> 01:30:07,440 DETERMINED, BUT WE REALLY DO 2508 01:30:07,440 --> 01:30:08,880 WANT TO MAKE SURE THAT THERE ARE 2509 01:30:08,880 --> 01:30:10,160 MULTIPLE WAYS FOR PEOPLE TO 2510 01:30:10,160 --> 01:30:11,880 ACCESS THIS INFORMATION, AND WE 2511 01:30:11,880 --> 01:30:12,680 ALSO, OF COURSE, IN THE 2512 01:30:12,680 --> 01:30:14,080 GOVERNMENT WANT TO MAKE SURE 2513 01:30:14,080 --> 01:30:15,920 THAT THE FULL DETAILS CAN BE 2514 01:30:15,920 --> 01:30:17,320 ACCESSIBLE THAT ARE NOT BEHIND 2515 01:30:17,320 --> 01:30:20,240 ANY SORT OF PAY WALL OR ANYTHING 2516 01:30:20,240 --> 01:30:23,000 LIKE THAT. 2517 01:30:23,000 --> 01:30:24,120 SO THESE ARE THE NEXT STEPS THAT 2518 01:30:24,120 --> 01:30:25,880 WE ARE GOING TO WORK THROUGH IN 2519 01:30:25,880 --> 01:30:28,600 THE COMING MONTHS. 2520 01:30:28,600 --> 01:30:29,720 SO STAY TUNED. 2521 01:30:29,720 --> 01:30:32,000 I THINK WHAT I CAN DO IS I WILL 2522 01:30:32,000 --> 01:30:35,880 PUT IN THE CHAT MY EMAIL SO I'M 2523 01:30:35,880 --> 01:30:38,640 THE CHIEF SCIENTIFIC AND PUBLIC 2524 01:30:38,640 --> 01:30:40,400 ENGAGEMENT AT NINDS, SO IF ANY 2525 01:30:40,400 --> 01:30:41,920 MEMBERS OF THE ATTENDEES TODAY 2526 01:30:41,920 --> 01:30:43,360 AND WE CAN UPDATE THE WEBSITE 2527 01:30:43,360 --> 01:30:44,960 WITH THIS TOO, IF YOU HAVE 2528 01:30:44,960 --> 01:30:45,880 ADDITIONAL IDEAS THAT COME TO 2529 01:30:45,880 --> 01:30:47,240 YOU FROM ALL THESE DISCUSSIONS 2530 01:30:47,240 --> 01:30:48,960 AND ALL THAT YOU'VE HEARD, IF 2531 01:30:48,960 --> 01:30:51,880 YOU GO BACK TO THE DRAFT REPORT 2532 01:30:51,880 --> 01:30:53,320 AND ARE REREADING IT A LITTLE 2533 01:30:53,320 --> 01:30:55,120 MORE CAREFULLY WITH THE 2534 01:30:55,120 --> 01:30:56,320 SYMPOSIUM PRESENTATIONS AND 2535 01:30:56,320 --> 01:30:58,320 DISCUSSIONS IN MIND, AND YOU 2536 01:30:58,320 --> 01:30:59,840 HAVE NEW IDEAS, DO FEEL FREE TO 2537 01:30:59,840 --> 01:31:01,800 SEND THEM OUR WAY AND I'M HAPPY 2538 01:31:01,800 --> 01:31:02,880 TO MAKE SURE THEY GET 2539 01:31:02,880 --> 01:31:05,800 DISTRIBUTED TO THE BRAIN ATTACK 2540 01:31:05,800 --> 01:31:06,400 COALITION, OUR STEERING 2541 01:31:06,400 --> 01:31:07,800 COMMITTEE AND THE THREE TASK 2542 01:31:07,800 --> 01:31:08,040 FORCES. 2543 01:31:08,040 --> 01:31:13,800 SO INTO THE CHAT. 2544 01:31:13,800 --> 01:31:15,320 I'M ALSO A PUBLIC SERVANT SO YOU 2545 01:31:15,320 --> 01:31:17,280 CAN FIND ME ON THE INTERNET, 2546 01:31:17,280 --> 01:31:18,840 SAMANTHA WHITE IS MY NAME IF YOU 2547 01:31:18,840 --> 01:31:21,880 MISS THIS, AND I THINK THAT IS 2548 01:31:21,880 --> 01:31:23,640 IT, MARK AND RICHARD, FROM ME. 2549 01:31:23,640 --> 01:31:24,800 >> THE OTHER THING WE'RE GOING 2550 01:31:24,800 --> 01:31:26,240 TO DO, SAM, AND AGAIN, THANK YOU 2551 01:31:26,240 --> 01:31:28,120 AND YOUR STAFF FOR ALL OF YOUR 2552 01:31:28,120 --> 01:31:29,640 HARD WORK AND SUPPORT, OBVIOUSLY 2553 01:31:29,640 --> 01:31:33,320 NINDS IS PART OF THE BAC AND 2554 01:31:33,320 --> 01:31:36,840 MEMBERS OF NINDS, YOU HEARD FROM 2555 01:31:36,840 --> 01:31:37,920 DR. KOROSHETZ YESTERDAY, CLINT 2556 01:31:37,920 --> 01:31:39,480 WRIGHT WAS ON FOR PART OF 2557 01:31:39,480 --> 01:31:41,520 YESTERDAY, NOT SURE IF HE WAS ON 2558 01:31:41,520 --> 01:31:43,920 TODAY, SCOTT JANIS WORKS 2559 01:31:43,920 --> 01:31:45,120 ACTIVELY WITH THE BAC. 2560 01:31:45,120 --> 01:31:46,240 WE WILL SHARE WITH THEM THE 2561 01:31:46,240 --> 01:31:48,320 RESULTS OF THE VARIOUS TASK 2562 01:31:48,320 --> 01:31:49,960 FORCES AND THE FINAL PUBLICATION 2563 01:31:49,960 --> 01:31:53,120 TO WORK WITH THEM AND IDENTIFY 2564 01:31:53,120 --> 01:31:54,880 WITH RICHARD'S SUPPORT 2565 01:31:54,880 --> 01:31:56,640 OBVIOUSLY, FUNDING 2566 01:31:56,640 --> 01:31:57,160 OPPORTUNITIES. 2567 01:31:57,160 --> 01:32:00,520 BE IT RFAs OR RFPs OR THINGS 2568 01:32:00,520 --> 01:32:02,320 THAT COULD LEAD TO TESTABLE 2569 01:32:02,320 --> 01:32:05,480 HYPOTHESES THAT HOPEFULLY WE CAN 2570 01:32:05,480 --> 01:32:06,760 WORK WITH GROUPS AND OTHER 2571 01:32:06,760 --> 01:32:08,640 PEOPLE TO WRITE GRANT PROPOSALS 2572 01:32:08,640 --> 01:32:10,400 THAT COULD GET FUNDED THROUGH 2573 01:32:10,400 --> 01:32:12,120 EITHER A NORMAL MECHANISM OR A 2574 01:32:12,120 --> 01:32:15,600 SPECIAL MECHANISM TO SUPPORT AND 2575 01:32:15,600 --> 01:32:16,560 ANSWER SOME OF THE GREAT 2576 01:32:16,560 --> 01:32:19,000 QUESTIONS AND SEEK SOLUTIONS TO 2577 01:32:19,000 --> 01:32:20,360 THE INEQUITIES AND DISPARITIES 2578 01:32:20,360 --> 01:32:21,600 THAT WERE IDENTIFIED OVER THE 2579 01:32:21,600 --> 01:32:24,800 PAST TWO DAYS. 2580 01:32:24,800 --> 01:32:26,520 >> AND JUST A QUICK POINT OF 2581 01:32:26,520 --> 01:32:33,040 CLARIFICATION ON THAT, SO THE 2582 01:32:33,040 --> 01:32:34,720 WAY THAT NINDS CREATES FUNDING 2583 01:32:34,720 --> 01:32:35,560 OPPORTUNITIES IS A VERY 2584 01:32:35,560 --> 01:32:36,520 REGULATED PROCESS, SO OF COURSE 2585 01:32:36,520 --> 01:32:37,680 ALL OF THE INFORMATION FROM THE 2586 01:32:37,680 --> 01:32:39,240 SYMPOSIUM AND THAT COMES OUT IN 2587 01:32:39,240 --> 01:32:41,720 THE FINAL REPORT, THE SHORT FORM 2588 01:32:41,720 --> 01:32:42,880 OF THE REPORT WILL BE 2589 01:32:42,880 --> 01:32:44,760 DISTRIBUTED BROADLY TO ALL 2590 01:32:44,760 --> 01:32:46,320 MEMBERS, ALL STAKEHOLDERS OF 2591 01:32:46,320 --> 01:32:48,040 NINDS, ALL THOSE INVESTED IN 2592 01:32:48,040 --> 01:32:52,120 STROKE, AND THEN ALONG THE WAY, 2593 01:32:52,120 --> 01:32:54,520 OUR PROGRAM STAFF AND OUR 2594 01:32:54,520 --> 01:32:55,720 LEADERSHIP SEPARATELY, ON THEIR 2595 01:32:55,720 --> 01:32:57,200 OWN, KIND OF GATHER INFORMATION 2596 01:32:57,200 --> 01:32:59,080 FROM THE STATE OF THE FIELD, 2597 01:32:59,080 --> 01:33:00,520 FROM CONVERSATIONS JUST LIKE 2598 01:33:00,520 --> 01:33:03,440 THESE, AND THEN WE SEPARATELY 2599 01:33:03,440 --> 01:33:04,880 COME UP WITH IDEAS. 2600 01:33:04,880 --> 01:33:06,400 THEY'RE CALLED FUNDING 2601 01:33:06,400 --> 01:33:07,840 OPPORTUNITY CONCEPTS, THAT THOSE 2602 01:33:07,840 --> 01:33:09,880 ACTUALLY HAVE TO DID TO OUR 2603 01:33:09,880 --> 01:33:13,320 FEDERAL ADVISORY COUNCIL FOR 2604 01:33:13,320 --> 01:33:14,520 APPROVAL, AND THEN UPON THAT 2605 01:33:14,520 --> 01:33:15,720 APPROVAL, THE PROGRAM STAFF CAN 2606 01:33:15,720 --> 01:33:18,920 START TO CREATE THESE FUNDING 2607 01:33:18,920 --> 01:33:21,240 OPPORTUNITIES, AGAIN WITH THEIR 2608 01:33:21,240 --> 01:33:22,640 EXPERIENCE AND EDUCATION FROM 2609 01:33:22,640 --> 01:33:26,480 OUR ENTIRE PORTFOLIO, FROM OTHER 2610 01:33:26,480 --> 01:33:28,000 WORK, RICHARD'S OFFICE HAS DONE 2611 01:33:28,000 --> 01:33:29,880 A HUGE AMOUNT OF WORK IN 2612 01:33:29,880 --> 01:33:31,240 STRATEGIC PLANNING IN THIS SAME 2613 01:33:31,240 --> 01:33:34,240 AREA, SO CERTAINLY INFORMED BY 2614 01:33:34,240 --> 01:33:35,480 THAT, AND THEN, OF COURSE, ONCE 2615 01:33:35,480 --> 01:33:37,040 WE HAVE ACTUALLY PUBLISHED 2616 01:33:37,040 --> 01:33:38,800 THOSE, THEY'RE PUBLISHED 2617 01:33:38,800 --> 01:33:40,320 PUBLICLY IN THE NIH GUIDE, AND 2618 01:33:40,320 --> 01:33:44,320 WE WILL CERTAINLY LOOP BACK TO 2619 01:33:44,320 --> 01:33:45,720 ALL ATTENDEES FROM THE SYMPOSIUM 2620 01:33:45,720 --> 01:33:49,640 TO LET YOU KNOW WHEN WE HAVE 2621 01:33:49,640 --> 01:33:51,520 OPPORTUNITIES FOR YOU TO APPLY 2622 01:33:51,520 --> 01:33:52,320 FOR THINGS. 2623 01:33:52,320 --> 01:33:53,680 BUT ALSO, THERE EVENTUALLY WILL 2624 01:33:53,680 --> 01:33:55,440 BE A APPROVAL FROM OUR COUNCIL 2625 01:33:55,440 --> 01:33:58,280 AND THAT ALWAYS HAPPENS IN THE 2626 01:33:58,280 --> 01:33:59,560 PUBLIC VERSION OF THAT MEETING. 2627 01:33:59,560 --> 01:34:01,320 SO THAT IS ALSO AN OPPORTUNITY 2628 01:34:01,320 --> 01:34:04,040 FOR YOU ALL TO REJOIN AND 2629 01:34:04,040 --> 01:34:05,800 ACTUALLY SEE THE CONCEPT THAT 2630 01:34:05,800 --> 01:34:06,800 OUR PROGRAM STAFF ARE ABLE TO 2631 01:34:06,800 --> 01:34:08,320 COME UP WITH ON THEIR OWN AND 2632 01:34:08,320 --> 01:34:09,880 SEE THE DISCUSSION THAT THEY 2633 01:34:09,880 --> 01:34:11,960 HAVE WITH OUR FEDERAL ADVISORY 2634 01:34:11,960 --> 01:34:16,240 COMMITTEE. 2635 01:34:16,240 --> 01:34:17,000 >> THANK YOU. 2636 01:34:17,000 --> 01:34:18,880 I DO WANT TO MAKE JUST A FEW 2637 01:34:18,880 --> 01:34:21,840 SHORT, BRIEF CLOSING REMARKS. 2638 01:34:21,840 --> 01:34:24,880 I'D FIRST LIKE TO THANK MARK FOR 2639 01:34:24,880 --> 01:34:27,600 YOUR GREAT LEADERSHIP, AND BEING 2640 01:34:27,600 --> 01:34:31,320 ABLE TO WORK BESIDE YOU IN 2641 01:34:31,320 --> 01:34:32,120 CO-CHAIRING THIS WORKSHOP THAT 2642 01:34:32,120 --> 01:34:35,520 WE'VE HAD THE LAST COUPLE OF 2643 01:34:35,520 --> 01:34:36,400 DAYS. 2644 01:34:36,400 --> 01:34:37,320 YOU'VE SHOWN GREAT LEADERSHIP. 2645 01:34:37,320 --> 01:34:38,520 I'VE LEARNED A LOT FROM YOU 2646 01:34:38,520 --> 01:34:40,840 DURING THIS PROCESS. 2647 01:34:40,840 --> 01:34:43,040 I'D ALSO LIKE TO THANK THE TASK 2648 01:34:43,040 --> 01:34:44,120 FORCE LEADS AS WELL AS THE TASK 2649 01:34:44,120 --> 01:34:45,720 FORCE MEMBERS FOR ALL OF THE 2650 01:34:45,720 --> 01:34:48,320 HARD WORK THAT YOU'VE DONE IN 2651 01:34:48,320 --> 01:34:49,520 TERMS OF PULLING THIS 2652 01:34:49,520 --> 01:34:51,000 INFORMATION TOGETHER, DOING THE 2653 01:34:51,000 --> 01:34:52,120 RESEARCH, AND THE PRESENTATION 2654 01:34:52,120 --> 01:34:56,200 THAT YOU'VE DONE TODAY. 2655 01:34:56,200 --> 01:34:57,320 SAM, HER LEADERSHIP AND HER 2656 01:34:57,320 --> 01:34:57,880 OFFICE FOR EVERYTHING THAT 2657 01:34:57,880 --> 01:34:59,200 THEY'VE DONE, I'M REALLY 2658 01:34:59,200 --> 01:35:00,080 GRATEFUL FOR THAT. 2659 01:35:00,080 --> 01:35:01,720 AND CLINT IS ON, AND SO WE'VE 2660 01:35:01,720 --> 01:35:03,800 ALREADY JUST SORT OF 2661 01:35:03,800 --> 01:35:05,320 INCORPORATED SOME OF THE 2662 01:35:05,320 --> 01:35:06,320 INFORMATION AND WE'VE THOUGHT 2663 01:35:06,320 --> 01:35:07,200 ABOUT SOME OF THE THINGS THAT 2664 01:35:07,200 --> 01:35:09,800 YOU'VE TALKED ABOUT, AND SO SOME 2665 01:35:09,800 --> 01:35:11,880 REALLY EXCITING THINGS AND SAM 2666 01:35:11,880 --> 01:35:13,800 SORT OF WENT THROUGH AND 2667 01:35:13,800 --> 01:35:14,480 OUTLINED THE PROCESS. 2668 01:35:14,480 --> 01:35:16,880 SO WE'RE REALLY EXCITED AT 2669 01:35:16,880 --> 01:35:18,400 WORKING WITH YOU AND ALL MEMBERS 2670 01:35:18,400 --> 01:35:21,920 OF THE BRAIN ATTACK COALITION 2671 01:35:21,920 --> 01:35:22,640 FOR ALL OF THE HARD WORK THAT 2672 01:35:22,640 --> 01:35:24,320 YOU'VE DONE, AND WE LOOK FORWARD 2673 01:35:24,320 --> 01:35:27,840 TO ITING TO WOR CONTINUING TO WORK WITH YO U. 2674 01:35:27,840 --> 01:35:28,760 >> SO THANK YOU ALL VERY MUCH 2675 01:35:28,760 --> 01:35:30,720 FOR YOUR TIME AND DISCRETIONARY 2676 01:35:30,720 --> 01:35:31,080 EFFORT. 2677 01:35:31,080 --> 01:35:32,360 I KNOW THERE'S A LOT GOING ON 2678 01:35:32,360 --> 01:35:33,480 WITH PANDEMIC AND NATIONAL 2679 01:35:33,480 --> 01:35:35,320 MEETINGS AND THINGS LIKE THAT, 2680 01:35:35,320 --> 01:35:37,280 AND I THINK FOR MANY OF US, THIS 2681 01:35:37,280 --> 01:35:39,600 IS A LABOR OF LOVE THAT HAVE A 2682 01:35:39,600 --> 01:35:41,440 CAREER RELATED TO STROKE 2683 01:35:41,440 --> 01:35:42,720 TREATMENT, STROKE PREVENTION AND 2684 01:35:42,720 --> 01:35:43,320 STROKE RECOVERY. 2685 01:35:43,320 --> 01:35:45,600 SO AGAIN, CAN'T THANK YOU ALL 2686 01:35:45,600 --> 01:35:46,720 ENOUGH, AND AGAIN, PLEASURE 2687 01:35:46,720 --> 01:35:48,200 WORKING WITH RICHARD AND SAM, 2688 01:35:48,200 --> 01:35:50,720 AND ALL OF THE PARTICIPANTS AND 2689 01:35:50,720 --> 01:35:51,520 TASK FORCE MEMBERS. 2690 01:35:51,520 --> 01:35:53,320 I THINK THIS IS THE SORT OF 2691 01:35:53,320 --> 01:35:54,680 EFFORT THAT WILL PAY DIVIDENDS 2692 01:35:54,680 --> 01:35:56,400 FOR YEARS TO COME. 2693 01:35:56,400 --> 01:35:58,280 MUCH AS THE NINDS SYMPOSIUM 2694 01:35:58,280 --> 01:36:01,000 RIGHT AFTER TPA GOT APPROVED HAS 2695 01:36:01,000 --> 01:36:03,320 REALLY PAID DIVIDENDS FOR 2696 01:36:03,320 --> 01:36:05,160 DECADES IN TERMS OF OFFERING 2697 01:36:05,160 --> 01:36:06,800 SOME GUIDANCE AND SOME FOUNDING 2698 01:36:06,800 --> 01:36:08,120 PRINCIPLES FOR HOW WE'RE GOING 2699 01:36:08,120 --> 01:36:10,320 TO USE THAT THERAPY AND NOW THIS 2700 01:36:10,320 --> 01:36:12,360 IS THE NEXT ITERATION OF THAT 2701 01:36:12,360 --> 01:36:14,200 WITH THE ADDED LAYER OF REALLY 2702 01:36:14,200 --> 01:36:17,480 FOCUSING ON DISPARITIES AND 2703 01:36:17,480 --> 01:36:18,680 INEQUITIES IN STROKE CARE AND 2704 01:36:18,680 --> 01:36:19,000 TREATMENT. 2705 01:36:19,000 --> 01:36:20,800 SO AGAIN, THANK YOU ALL VERY 2706 01:36:20,800 --> 01:36:21,000 MUCH. 2707 01:36:21,000 --> 01:36:23,040 HOPE YOU ALL HAVE A GREAT 2708 01:36:23,040 --> 01:36:24,120 WEEKEND, AND A SAFE SUMMER, AND 2709 01:36:24,120 --> 01:36:26,200 WE WILL BE BACK IN TOUCH WITH 2710 01:36:26,200 --> 01:36:27,840 YOU IN PROBABLY A FEW MONTHS 2711 01:36:27,840 --> 01:36:29,880 WITH A DRAFT FOR YOU TO REVIEW 2712 01:36:29,880 --> 01:36:31,880 AND THEN FURTHER FEEDBACK AND 2713 01:36:31,880 --> 01:36:33,720 THEN PUBLICATION ON A WEBSITE 2714 01:36:33,720 --> 01:36:36,760 AND HOPEFULLY IN A JOURNAL. 2715 01:36:36,760 --> 01:36:38,440 >> THANK YOU, MARK. 2716 01:36:38,440 --> 01:36:40,920 AND I DO WANT TO JUST ALSO GIVE 2717 01:36:40,920 --> 01:36:42,880 KUDOS TO THE OTHER MEMBERS OF 2718 01:36:42,880 --> 01:36:45,320 THE NINDS TEAM AND OUR LOGISTICS 2719 01:36:45,320 --> 01:36:46,880 CONTRACTOR WHO HAVE BEEN WORKING 2720 01:36:46,880 --> 01:36:48,080 TIRELESSLY TO SUPPORT ALL THE 2721 01:36:48,080 --> 01:36:49,480 TASK FORCES AND TO ACTUALLY RUN 2722 01:36:49,480 --> 01:36:50,120 THE SYMPOSIUM. 2723 01:36:50,120 --> 01:36:52,880 SO OUR CONTRACTORS, ROSALY AND 2724 01:36:52,880 --> 01:36:53,960 ASSOCIATES, THEY HAVE BEEN 2725 01:36:53,960 --> 01:36:56,920 FANTASTIC ALONG THE WAY AS WE 2726 01:36:56,920 --> 01:36:58,120 REALLY HAVE BEEN PULLING ALL THE 2727 01:36:58,120 --> 01:37:00,080 INFORMATION TOGETHER, GETTING 2728 01:37:00,080 --> 01:37:02,800 MEETING WEBSITE, RUNNING THE 2729 01:37:02,800 --> 01:37:07,520 ZOOM, THEY ARE DOING THIS. 2730 01:37:07,520 --> 01:37:09,120 THANKING VIDEOCAST MAKING SURE 2731 01:37:09,120 --> 01:37:11,200 THIS IS PUBLICLY ACCESSIBLE, AND 2732 01:37:11,200 --> 01:37:12,240 ARCHIVED SO YOU CAN PUBLICLY 2733 01:37:12,240 --> 01:37:12,640 VIEW THIS. 2734 01:37:12,640 --> 01:37:14,120 YOU CAN EXTEND MEETING LINK TO 2735 01:37:14,120 --> 01:37:15,000 YOUR COLLEAGUES AND THEY WILL 2736 01:37:15,000 --> 01:37:16,520 ALSO BE ABLE TO SEE IT EVEN IF 2737 01:37:16,520 --> 01:37:17,920 THEY COULDN'T ATTEND TODAY OR 2738 01:37:17,920 --> 01:37:19,680 WERE NOT REGISTERED. 2739 01:37:19,680 --> 01:37:21,760 I ALSO WANT TO THANK MY NINDS 2740 01:37:21,760 --> 01:37:23,320 COLLEAGUES WHO WERE FACILITATING 2741 01:37:23,320 --> 01:37:26,560 EVERYTHING ALL ALONG, BUT EACH 2742 01:37:26,560 --> 01:37:28,520 OF THE TASK FORCES HAD SUPPORT 2743 01:37:28,520 --> 01:37:30,720 THAT CAME FROM ANDREA -- I'M 2744 01:37:30,720 --> 01:37:32,600 SORRY, IT DID COME FROM ANDREA, 2745 01:37:32,600 --> 01:37:35,520 BUT IT CAME FROM DIANA, RYAN, 2746 01:37:35,520 --> 01:37:37,400 AND CARLO, AND THEN ALSO WE HAD 2747 01:37:37,400 --> 01:37:41,120 OUR FABULOUS SCIENCE WRITER ON 2748 01:37:41,120 --> 01:37:42,760 STAFF, NINA, WHO HAS BEEN REALLY 2749 01:37:42,760 --> 01:37:44,400 DOING A HEROIC EFFORT IN TERMS 2750 01:37:44,400 --> 01:37:45,920 OF REALLY WRANGLING EVERYTHING 2751 01:37:45,920 --> 01:37:47,040 AND FORMATTING THE DRAFT REPORT 2752 01:37:47,040 --> 01:37:49,440 THAT YOU ALL SAW, AND SHE AND 2753 01:37:49,440 --> 01:37:50,400 CARLO WILL CONTINUE TO WORK WITH 2754 01:37:50,400 --> 01:37:52,720 THE TASK FORCES TO FORMAT THE 2755 01:37:52,720 --> 01:37:53,960 FINAL PRODUCT AS WE MOVE FORWARD 2756 01:37:53,960 --> 01:37:55,440 IN THE COMING MONTHS. 2757 01:37:55,440 --> 01:37:57,360 SO, WITH THAT, THANK YOU ALL, 2758 01:37:57,360 --> 01:37:58,840 THANK YOU, MARK, THANK YOU, 2759 01:37:58,840 --> 01:38:00,080 RICHARD, THANK YOU TO ALL OF OUR 2760 01:38:00,080 --> 01:38:02,520 TASK FORCES AND THE BAC, AND I 2761 01:38:02,520 --> 01:38:03,840 THINK WE CAN CLOSE OUT A BIT 2762 01:38:03,840 --> 01:38:05,520 EARLY. 2763 01:38:05,520 --> 01:38:06,880 >> THANK YOU ALL. 2764 01:38:06,880 --> 01:38:08,000 THANKS, SAM. 2765 01:38:08,000 --> 01:38:09,320 THANK YOU. 2766 01:38:09,320 --> 01:38:11,160 HAVE A GOOD WEEKEND. 2767 01:38:11,160 --> 01:39:44,280 >> BYE, EVERYONE.